MEDICARE: JASMINE BRUNER

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E1478457	OTHER	CA	MEDICAL

General Provider Information

NPI Number	:	1922768498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE BRUNER

Provider Business Mailing Address
First Line	:	7077 BURCOT AVE APT 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89156-6180
Country	:	US
Telephone Number	:	191-627-7415
Fax Number	:

Provider Business Practice Location Address
First Line	:	7077 BURCOT AVE APT 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89156-6180
Country	:	US
Telephone Number	:	916-277-4155
Fax Number	:

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

Provider Enumeration Date	:	12/26/2021
Last Update Date	:	12/26/2021

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Directions to “ JASMINE BRUNER ” Practice Location

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