Provider Demographics
NPI:1801628565
Name:SANDERS, JASMINE ALEXIS (LPN)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:ALEXIS
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 PEPPERCORN LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-4263
Mailing Address - Country:US
Mailing Address - Phone:803-801-0445
Mailing Address - Fax:
Practice Address - Street 1:1421 BLUFF RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-4809
Practice Address - Country:US
Practice Address - Phone:803-805-6989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50524164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse