Provider Demographics
NPI:1205225224
Name:DOCKENDORF, JAMIE MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:MARIE
Last Name:DOCKENDORF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:MARIE
Other - Last Name:SPODEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1301 33RD ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-9668
Mailing Address - Country:US
Mailing Address - Phone:320-251-8181
Mailing Address - Fax:
Practice Address - Street 1:1301 33RD ST S
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-9668
Practice Address - Country:US
Practice Address - Phone:320-251-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant