Provider Demographics
NPI:1033412531
Name:PLETT, JAMIE LYNN (MD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:PLETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6030 GARRETT LN
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-6637
Mailing Address - Country:US
Mailing Address - Phone:815-226-1172
Mailing Address - Fax:815-226-1595
Practice Address - Street 1:6030 GARRETT LN
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6637
Practice Address - Country:US
Practice Address - Phone:815-226-1172
Practice Address - Fax:815-226-1595
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106453207VG0400X, 207VX0000X
IL036-128001207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics