Provider Demographics
NPI:1154879567
Name:WILLIAM, JAZMINE (LPN)
Entity type:Individual
Prefix:
First Name:JAZMINE
Middle Name:
Last Name:WILLIAM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19178 HUBBELL ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-1927
Mailing Address - Country:US
Mailing Address - Phone:313-721-3350
Mailing Address - Fax:
Practice Address - Street 1:19178 HUBBELL
Practice Address - Street 2:19178 HUBBELL
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-1927
Practice Address - Country:US
Practice Address - Phone:313-721-3350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703116982164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse