Provider Demographics
NPI:1235139262
Name:NOTES, JACKIE L (CNM)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:L
Last Name:NOTES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:2 MERIDIAN BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3202
Mailing Address - Country:US
Mailing Address - Phone:610-372-4957
Mailing Address - Fax:610-372-3735
Practice Address - Street 1:10710 CHARTER DR
Practice Address - Street 2:MEDICAL PAVILION AT HOWARD COUNTY-SUITE 200
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3128
Practice Address - Country:US
Practice Address - Phone:410-884-8000
Practice Address - Fax:410-740-8587
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2015-01-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDR100098367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD699072000Medicaid
MD699072000Medicaid
MDR12648Medicare UPIN