Provider Demographics
NPI:1619282167
Name:KNECE, JAMIE MELISA (LPN)
Entity Type:Individual
Prefix:MISS
First Name:JAMIE
Middle Name:MELISA
Last Name:KNECE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4533 BROWNIE RD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33953-5934
Mailing Address - Country:US
Mailing Address - Phone:941-565-3454
Mailing Address - Fax:
Practice Address - Street 1:66 KNOLLWOOD CT
Practice Address - Street 2:
Practice Address - City:SOUTH BLOOMFIELD
Practice Address - State:OH
Practice Address - Zip Code:43103-2003
Practice Address - Country:US
Practice Address - Phone:740-983-2640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-09
Last Update Date:2019-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.134024-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse