Provider Demographics
NPI:1477567063
Name:HAIN, JAMIE M (CNP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:M
Last Name:HAIN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2980 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1834
Mailing Address - Country:US
Mailing Address - Phone:330-759-2310
Mailing Address - Fax:330-759-0018
Practice Address - Street 1:2980 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1834
Practice Address - Country:US
Practice Address - Phone:330-759-2310
Practice Address - Fax:330-759-0018
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN173920363L00000X, 364SP0809X
OHCOA.06522-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2527206Medicaid
OHHANP12903Medicare ID - Type Unspecified
P86988Medicare UPIN