Provider Demographics
NPI:1689275604
Name:PATEL, JAMIE (CNP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:ATHOL
Mailing Address - State:MA
Mailing Address - Zip Code:01331-2119
Mailing Address - Country:US
Mailing Address - Phone:978-249-0099
Mailing Address - Fax:978-249-7227
Practice Address - Street 1:201 S MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:ATHOL
Practice Address - State:MA
Practice Address - Zip Code:01331-2119
Practice Address - Country:US
Practice Address - Phone:978-249-0099
Practice Address - Fax:978-249-7227
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2332663363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily