Provider Demographics
NPI:1912604364
Name:GLOVER, JASMINE ((RN))
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:GLOVER
Suffix:
Gender:F
Credentials:(RN)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 OTTERBEIN AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-4007
Mailing Address - Country:US
Mailing Address - Phone:937-329-6437
Mailing Address - Fax:
Practice Address - Street 1:3411 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45439-2298
Practice Address - Country:US
Practice Address - Phone:937-802-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH539679163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH009128Medicaid
OH0411413Medicaid