MEDICARE: JASMINE RENEE AAENSON B.S.W

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1972940997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE RENEE AAENSON B.S.W

Provider Business Mailing Address
First Line	:	821 S QUINCY AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74120-4623
Country	:	US
Telephone Number	:	918-407-5744
Fax Number	:

Provider Business Practice Location Address
First Line	:	821 S QUINCY AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74120-4623
Country	:	US
Telephone Number	:	918-407-5744
Fax Number	:

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

Provider Enumeration Date	:	05/30/2013
Last Update Date	:	05/30/2013

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