Provider Demographics
NPI:1245784909
Name:ERNEST, JAMIEJO (LPN)
Entity Type:Individual
Prefix:
First Name:JAMIEJO
Middle Name:
Last Name:ERNEST
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:ERNEST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:1913 68TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-3714
Mailing Address - Country:US
Mailing Address - Phone:253-576-4508
Mailing Address - Fax:
Practice Address - Street 1:1913 68TH AVE NE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-3714
Practice Address - Country:US
Practice Address - Phone:253-576-4508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60594621164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse