Provider Demographics
NPI:1093340499
Name:GREENBLATT, JAMIE MICHELLE (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:MICHELLE
Last Name:GREENBLATT
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2796 TOMLINSON RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-9716
Mailing Address - Country:US
Mailing Address - Phone:517-604-0165
Mailing Address - Fax:
Practice Address - Street 1:230 TEMPLE ST
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-1851
Practice Address - Country:US
Practice Address - Phone:517-676-9066
Practice Address - Fax:517-676-3505
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704272868207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine