Healthcare Provider Details

I. General information

NPI: 1154706679
Provider Name (Legal Business Name): JASMINE GETTYS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2015
Last Update Date: 07/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 FULTON ST
DURHAM NC
27705-3875
US

IV. Provider business mailing address

6404 MONTERREY CREEK DR APT 303
DURHAM NC
27713-6276
US

V. Phone/Fax

Practice location:
  • Phone: 919-286-0411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number279359
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number79350
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: