Provider Demographics
NPI:1639330715
Name:SUBUH, JAMIE D (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:D
Last Name:SUBUH
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8718 CHALET DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-5258
Mailing Address - Country:US
Mailing Address - Phone:316-687-6287
Mailing Address - Fax:316-687-6287
Practice Address - Street 1:8718 CHALET DR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-5258
Practice Address - Country:US
Practice Address - Phone:316-687-6287
Practice Address - Fax:316-687-6287
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-77854-102163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management