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General NPI Number Information
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NPI Number | 1205214178
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Entity Type | Individual
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Provider Name | JASMINE JOHN MD
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Gender | Female
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Dates
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Enumeration Date | 05/12/2015
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Last Update Date | 02/12/2020
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Provider Practice Location Address
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Address Line | 3021 VOYAGER DR
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City | GREEN BAY
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State | WI
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Zip | 54311-8303
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Country | US
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Telephone | 920-496-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 3021 VOYAGER DR
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City | GREEN BAY
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State | WI
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Zip | 54311-8303
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Country | US
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Telephone | 920-496-4700
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0500X
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Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
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License Number | 72055-20
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License Number State | WI
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