Provider Demographics
NPI:1871018259
Name:KANEVSKI, JASMIN SUZANNE SUN (MBA, LM, CPM)
Entity type:Individual
Prefix:
First Name:JASMIN
Middle Name:SUZANNE SUN
Last Name:KANEVSKI
Suffix:
Gender:F
Credentials:MBA, LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 TRAVIS RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-4945
Mailing Address - Country:US
Mailing Address - Phone:682-365-4488
Mailing Address - Fax:682-842-1027
Practice Address - Street 1:337 TRAVIS RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-4945
Practice Address - Country:US
Practice Address - Phone:682-365-4448
Practice Address - Fax:682-842-1027
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99300176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife