Provider Demographics
NPI:1568100535
Name:WALCHESKI, JAMIE ALICE
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:ALICE
Last Name:WALCHESKI
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 1:1220 HURON RD E APT 404
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-1732
Mailing Address - Country:US
Mailing Address - Phone:610-730-0708
Mailing Address - Fax:
Practice Address - Street 1:1220 HURON RD E APT 404
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-1732
Practice Address - Country:US
Practice Address - Phone:610-730-0708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant