Provider Demographics
NPI:1528848330
Name:DAVIS, JASMINE TIARA
Entity type:Individual
Prefix:MS
First Name:JASMINE
Middle Name:TIARA
Last Name:DAVIS
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 1:750 1ST ST NW APT 115
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-5585
Mailing Address - Country:US
Mailing Address - Phone:616-500-3034
Mailing Address - Fax:
Practice Address - Street 1:750 1ST ST NW APT 115
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-5585
Practice Address - Country:US
Practice Address - Phone:616-500-3034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula