MEDICARE: WANDA JASPER

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1629801907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WANDA JASPER

Provider Business Mailing Address
First Line	:	6204 GUINEVERE CT
Second Line	:
City	:	GLENN DALE
State	:	MD
Zip	:	20769-8944
Country	:	US
Telephone Number	:	240-300-2396
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 MARION BARRY AVE SE APT 425
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-5118
Country	:	US
Telephone Number	:	240-300-2396
Fax Number	:

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

Provider Enumeration Date	:	08/22/2024
Last Update Date	:	08/29/2024

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Directions to “ WANDA JASPER ” Practice Location

Language	Start Address	Practice Location

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