Healthcare Provider Details

I. General information

NPI: 1699595017
Provider Name (Legal Business Name): JAZMINE NICOLE WILLIAMSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10112 PARKVIEW AVE
GARFIELD HEIGHTS OH
44125-1530
US

IV. Provider business mailing address

10112 PARKVIEW AVE
GARFIELD HEIGHTS OH
44125-1530
US

V. Phone/Fax

Practice location:
  • Phone: 216-773-8541
  • Fax:
Mailing address:
  • Phone: 216-773-8541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246ZE0500X
TaxonomyEEG Specialist/Technologist
License Number7576
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: