Healthcare Provider Details

I. General information

NPI: 1013388321
Provider Name (Legal Business Name): JASMINE ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 BUCKINGHAM ST SW
GRAND RAPIDS MI
49548-1163
US

IV. Provider business mailing address

31 BUCKINGHAM ST SW
GRAND RAPIDS MI
49548-5401
US

V. Phone/Fax

Practice location:
  • Phone: 616-329-6032
  • Fax:
Mailing address:
  • Phone: 616-329-6032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: