Provider Demographics
NPI:1396022331
Name:JAMISON, MICHELLE ROXANNE (RN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ROXANNE
Last Name:JAMISON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 E HARRISON DR
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-2781
Mailing Address - Country:US
Mailing Address - Phone:567-868-2174
Mailing Address - Fax:
Practice Address - Street 1:909 E HARRISON DR
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-2781
Practice Address - Country:US
Practice Address - Phone:567-868-2174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN168325163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse