Provider Demographics
NPI:1740506112
Name:JASMIN, RODELINE
Entity type:Individual
Prefix:MS
First Name:RODELINE
Middle Name:
Last Name:JASMIN
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 1:2902 CORTELYOU RD # A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-6374
Mailing Address - Country:US
Mailing Address - Phone:718-287-4300
Mailing Address - Fax:718-287-4600
Practice Address - Street 1:2902 CORTELYOU RD # A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-6374
Practice Address - Country:US
Practice Address - Phone:718-287-4300
Practice Address - Fax:718-287-4600
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-10
Last Update Date:2010-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3005981164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse