Provider Demographics
NPI:1366931198
Name:ANDERSON, JASMYN LYNNEE
Entity type:Individual
Prefix:
First Name:JASMYN
Middle Name:LYNNEE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 CRYSTAL WATER DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-8635
Mailing Address - Country:US
Mailing Address - Phone:470-207-4280
Mailing Address - Fax:
Practice Address - Street 1:1045 CRYSTAL WATER DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-8635
Practice Address - Country:US
Practice Address - Phone:470-207-4280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0014201764376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide