Individual
JASMINE MALLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
4420 LAKE BOONE TRL, RALEIGH, NC 27607-7505
(585) 880-4327
Mailing address
224 BERRY MILL LN, RALEIGH, NC 27603-4579
(585) 880-4327
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
269686
SC
367500000X
Certified Registered Nurse Anesthetist
Primary
269686
SC
Other
Enumeration date
01/08/2024
Last updated
06/07/2026
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