Provider Demographics
NPI:1215297056
Name:JASAMES, LYNNE LARENE (MBA)
Entity type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:LARENE
Last Name:JASAMES
Suffix:
Gender:F
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6955 N DURANGO DR
Mailing Address - Street 2:1115-224
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4411
Mailing Address - Country:US
Mailing Address - Phone:702-743-2630
Mailing Address - Fax:
Practice Address - Street 1:6955 N DURANGO DR
Practice Address - Street 2:1115-224
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4411
Practice Address - Country:US
Practice Address - Phone:702-743-2630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-28
Last Update Date:2012-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner