Provider Demographics
NPI:1871346262
Name:JASKOWIAK, SAMMIE ALLISON
Entity type:Individual
Prefix:MS
First Name:SAMMIE
Middle Name:ALLISON
Last Name:JASKOWIAK
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 1:325 SOUTH ST APT 202
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MI
Mailing Address - Zip Code:49064-9532
Mailing Address - Country:US
Mailing Address - Phone:269-264-2675
Mailing Address - Fax:
Practice Address - Street 1:325 SOUTH ST APT 109
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MI
Practice Address - Zip Code:49064-9530
Practice Address - Country:US
Practice Address - Phone:269-264-2675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7575335163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health