Provider Demographics
NPI:1649094947
Name:ROBERTSON, JASMINE (HIS)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 PARKWAY ST STE E
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1693
Mailing Address - Country:US
Mailing Address - Phone:336-272-1721
Mailing Address - Fax:336-272-9069
Practice Address - Street 1:405 PARKWAY ST STE E
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1693
Practice Address - Country:US
Practice Address - Phone:336-272-1721
Practice Address - Fax:336-272-9069
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1685237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist