Provider Demographics
NPI:1417209552
Name:KIENITZ, JAMIE ANN (RN)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:ANN
Last Name:KIENITZ
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 1:9216 PAGE AVE NE
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MN
Mailing Address - Zip Code:55330-7255
Mailing Address - Country:US
Mailing Address - Phone:763-670-7102
Mailing Address - Fax:
Practice Address - Street 1:9216 PAGE AVE NE
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MN
Practice Address - Zip Code:55330-7255
Practice Address - Country:US
Practice Address - Phone:763-670-7102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-14
Last Update Date:2012-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 196254-5163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health