Individual
JASMINE BOVA GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1315 MARION AVE, SOUTH MILWAUKEE, WI 53172-3007
(414) 795-1710
Mailing address
1236 CRANE MEADOW WAY, SUN PRAIRIE, WI 53590-9010
(414) 841-5109
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100229226
—
WI
Enumeration date
09/23/2024
Last updated
09/23/2024
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