Provider Demographics
NPI:1245559061
Name:JADID, JAMIE L (APN)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:JADID
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 PINTO LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4004
Mailing Address - Country:US
Mailing Address - Phone:702-382-3200
Mailing Address - Fax:702-382-3575
Practice Address - Street 1:2011 PINTO LN
Practice Address - Street 2:SUITE 200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4004
Practice Address - Country:US
Practice Address - Phone:702-382-3200
Practice Address - Fax:702-382-3575
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN001199363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVRN 17892OtherLICENSE
NVRN 17892OtherLICENSE