Individual
JASMINE C GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1300 N VEL R PHILLIPS AVE APT 301, MILWAUKEE, WI 53212-4008
(141) 455-1541
(414) 551-5416
Mailing address
1300 N VEL R PHILLIPS AVE APT 301, MILWAUKEE, WI 53212-4008
(141) 455-1547
(414) 551-5416
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
81-4909668
—
WI
Enumeration date
07/27/2020
Last updated
07/27/2020
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