Provider Demographics
NPI:1689421208
Name:MATHERSON- WHITE, JAZMINE EVONNE
Entity type:Individual
Prefix:
First Name:JAZMINE
Middle Name:EVONNE
Last Name:MATHERSON- WHITE
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 1:638 E 87TH STREET
Mailing Address - Street 2:1R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3404
Mailing Address - Country:US
Mailing Address - Phone:929-561-3100
Mailing Address - Fax:
Practice Address - Street 1:638 E 87TH STREET
Practice Address - Street 2:1R
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3404
Practice Address - Country:US
Practice Address - Phone:929-561-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula