MEDICARE: JASMINE BOVA GRAY

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922825769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE BOVA GRAY

Provider Business Mailing Address
First Line	:	1236 CRANE MEADOW WAY
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-9010
Country	:	US
Telephone Number	:	414-841-5109
Fax Number	:

Provider Business Practice Location Address
First Line	:	1315 MARION AVE
Second Line	:
City	:	SOUTH MILWAUKEE
State	:	WI
Zip	:	53172-3007
Country	:	US
Telephone Number	:	414-795-1710
Fax Number	:

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

Provider Enumeration Date	:	09/23/2024
Last Update Date	:	09/23/2024

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Directions to “ JASMINE BOVA GRAY ” Practice Location

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