Healthcare Provider Details

I. General information

NPI: 1144190661
Provider Name (Legal Business Name): JAZZ-MINE RAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 JOHNSON AVE NW STE 5
CEDAR RAPIDS IA
52405-4762
US

IV. Provider business mailing address

1890 DOWS ST
ELY IA
52227-9572
US

V. Phone/Fax

Practice location:
  • Phone: 319-536-4434
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: