Provider Demographics
NPI:1558132126
Name:WEDGE, JAMIE M-E (PARA TATTOOIST MEDIC)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:M-E
Last Name:WEDGE
Suffix:
Gender:F
Credentials:PARA TATTOOIST MEDIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 EMERALD CIRCLE
Mailing Address - Street 2:
Mailing Address - City:WHITMORE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48189
Mailing Address - Country:US
Mailing Address - Phone:734-386-9105
Mailing Address - Fax:
Practice Address - Street 1:9541 MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITMORE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48189
Practice Address - Country:US
Practice Address - Phone:734-333-5067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBA-01066174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist