Provider Demographics
NPI:1629381835
Name:MOERS, JAMIE DONNA
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:DONNA
Last Name:MOERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:DONNA
Other - Last Name:BENDELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2814 CLAYTON CT
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-5415
Mailing Address - Country:US
Mailing Address - Phone:734-329-2412
Mailing Address - Fax:
Practice Address - Street 1:2814 CLAYTON CT
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-5415
Practice Address - Country:US
Practice Address - Phone:734-329-2412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703057593164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4703057593OtherLPN-LICENSED PRACTICAL NURSE