Provider Demographics
NPI:1477019370
Name:SHROYER, JAIME MALINDA
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:MALINDA
Last Name:SHROYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6373
Mailing Address - Country:US
Mailing Address - Phone:740-387-5210
Mailing Address - Fax:
Practice Address - Street 1:320 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6373
Practice Address - Country:US
Practice Address - Phone:740-387-5210
Practice Address - Fax:740-382-3713
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.149947.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse