Healthcare Provider Details

I. General information

NPI: 1245155134
Provider Name (Legal Business Name): ANASTATIA JASPER BSN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CENTRAL AVE SE
ALBUQUERQUE NM
87106-4930
US

IV. Provider business mailing address

1100 CENTRAL AVE SE
ALBUQUERQUE NM
87106-4930
US

V. Phone/Fax

Practice location:
  • Phone: 505-841-1295
  • Fax:
Mailing address:
  • Phone: 505-841-1295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number73825
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: