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NPI Code Detail

MEDICARE: JASMIN BLUE

MEDICARE:   JASMIN  BLUE
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
1164W00000XLicensed Practical NursePN152427 M IVOH

General Provider Information

NPI Number : 1902349616
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASMIN BLUE
Provider Business Mailing Address
First Line : 6015 SWEET BIRCH DR
Second Line :
City : BEDFORD HEIGHTS
State : OH
Zip : 44146-3073
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6015 SWEET BIRCH DR
Second Line :
City : BEDFORD HEIGHTS
State : OH
Zip : 44146-3073
Country : US
Telephone Number : 216-924-7426
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2016
Last Update Date : 11/29/2016

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Directions to “ JASMIN BLUE ” Practice Location

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