Provider Demographics
NPI:1932708575
Name:JOHNSON, JASMINE ANITA
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:ANITA
Last Name:JOHNSON
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 1:431 HAYES ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46404-1135
Mailing Address - Country:US
Mailing Address - Phone:219-302-1456
Mailing Address - Fax:
Practice Address - Street 1:431 HAYES ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-1135
Practice Address - Country:US
Practice Address - Phone:219-302-1456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-24
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide