Provider Demographics
NPI:1063056331
Name:WHITAKER, JASMINE (MBA)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4688 WALFORD RD APT 8
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5116
Mailing Address - Country:US
Mailing Address - Phone:216-414-3950
Mailing Address - Fax:
Practice Address - Street 1:5198 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:BEDFORD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44146-1331
Practice Address - Country:US
Practice Address - Phone:216-414-3950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2024-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246YR1600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationRegistered Record Administrator
No171M00000XOther Service ProvidersCase Manager/Care Coordinator