Individual
ANGEL CELESTE JASPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10550 LINDEN LAKE PLZ, MANASSAS, VA 20109-6495
(571) 921-0643
Mailing address
10550 LINDEN LAKE PLZ, MANASSAS, VA 20109-6495
(571) 921-0643
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
0002054616
VA
Other
Enumeration date
12/19/2019
Last updated
12/19/2019
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