Provider Demographics
NPI:1588834097
Name:BARNUM, JAMIE MARIE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:MARIE
Last Name:BARNUM
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5315 IDAHO AVE APT B
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98433-1626
Mailing Address - Country:US
Mailing Address - Phone:360-708-1970
Mailing Address - Fax:
Practice Address - Street 1:5315 IDAHO AVE APT B
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98433-1626
Practice Address - Country:US
Practice Address - Phone:360-708-1970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60000962174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist