Provider Demographics
NPI:1275042632
Name:NEIS, JAMIE MICHELLE
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:MICHELLE
Last Name:NEIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JAMIE
Other - Middle Name:M
Other - Last Name:NEIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:16 CONKEY AVE APT 1R
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1706
Mailing Address - Country:US
Mailing Address - Phone:607-334-1600
Mailing Address - Fax:607-334-1667
Practice Address - Street 1:31 BEEBE AVE
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1701
Practice Address - Country:US
Practice Address - Phone:607-334-1600
Practice Address - Fax:607-334-1667
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY707981163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse