Provider Demographics
NPI:1134301757
Name:IMHOFF, JAMIE (LPN)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:
Last Name:IMHOFF
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9002 W EL CAMINITO DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-7858
Mailing Address - Country:US
Mailing Address - Phone:480-543-0146
Mailing Address - Fax:
Practice Address - Street 1:4502 N CENTRAL AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1817
Practice Address - Country:US
Practice Address - Phone:602-764-1008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP043789164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse