MEDICARE: JASMIN BIANCA HOLDER R.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	482524	NY

General Provider Information

NPI Number	:	1083089619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMIN BIANCA HOLDER R.N.

Provider Business Mailing Address
First Line	:	1507 METROPOLITAN AVE
Second Line	:	APT 1E
City	:	BRONX
State	:	NY
Zip	:	10462-6173
Country	:	US
Telephone Number	:	845-538-0469
Fax Number	:

Provider Business Practice Location Address
First Line	:	1507 METROPOLITAN AVE
Second Line	:	APT 1E
City	:	BRONX
State	:	NY
Zip	:	10462-6173
Country	:	US
Telephone Number	:	845-538-0469
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2015
Last Update Date	:	12/08/2015

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