Provider Demographics
NPI:1467944405
Name:ECKENROD, JAMIE (CRNP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:ECKENROD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ROSE STREET
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4327
Mailing Address - Country:US
Mailing Address - Phone:814-539-0257
Mailing Address - Fax:814-536-0963
Practice Address - Street 1:16 ROSE STREET
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-4327
Practice Address - Country:US
Practice Address - Phone:814-539-0257
Practice Address - Fax:814-536-0963
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018587363LA2100X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care