Provider Demographics
NPI:1619465887
Name:JAMISON, JACQUELINE KATE
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:KATE
Last Name:JAMISON
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 1:3148 E 2ND ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-4240
Mailing Address - Country:US
Mailing Address - Phone:925-334-8927
Mailing Address - Fax:
Practice Address - Street 1:3148 E 2ND ST UNIT 2
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-4240
Practice Address - Country:US
Practice Address - Phone:925-334-8927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant