Healthcare Provider Details

I. General information

NPI: 1881153476
Provider Name (Legal Business Name): JASMINE SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2019
Last Update Date: 03/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 W 59TH ST
INDIANAPOLIS IN
46228-1722
US

IV. Provider business mailing address

4164 N BUTLER AVE
INDIANAPOLIS IN
46226-4628
US

V. Phone/Fax

Practice location:
  • Phone: 317-457-1163
  • Fax:
Mailing address:
  • Phone: 317-457-1163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: