Provider Demographics
NPI:1649787854
Name:SWAYZE, JASIMINE MARIE
Entity type:Individual
Prefix:
First Name:JASIMINE
Middle Name:MARIE
Last Name:SWAYZE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2028 NORTHGATE DR NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-3739
Mailing Address - Country:US
Mailing Address - Phone:319-202-0010
Mailing Address - Fax:
Practice Address - Street 1:2028 NORTHGATE DR NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-3739
Practice Address - Country:US
Practice Address - Phone:319-202-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAP56813164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse