Provider Demographics
NPI:1215082292
Name:WASMER, JEANNIE MARIE (SA-C)
Entity type:Individual
Prefix:MRS
First Name:JEANNIE
Middle Name:MARIE
Last Name:WASMER
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:MISS
Other - First Name:JEANNIE
Other - Middle Name:MARIE
Other - Last Name:HINKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7432 CAMIO AVE
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-3062
Mailing Address - Country:US
Mailing Address - Phone:321-960-8190
Mailing Address - Fax:321-735-0243
Practice Address - Street 1:7432 CAMIO AVE
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32927-3062
Practice Address - Country:US
Practice Address - Phone:321-960-8190
Practice Address - Fax:321-735-0243
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist