Provider Demographics
NPI:1568681989
Name:JAMIESON, MAUREEN RENEE (RD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:RENEE
Last Name:JAMIESON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52077 LOCKS LN
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-9591
Mailing Address - Country:US
Mailing Address - Phone:574-272-7554
Mailing Address - Fax:
Practice Address - Street 1:MEMORIAL HOSPITAL
Practice Address - Street 2:615 N MICHIGAN
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601
Practice Address - Country:US
Practice Address - Phone:574-647-6353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN835697133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered