Provider Demographics
NPI:1699197293
Name:PRICE, JAMIE LEE
Entity Type:Individual
Prefix:
First Name:JAMIE LEE
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAMIE LEE
Other - Middle Name:
Other - Last Name:LATHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:243 CORBIN RD
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:13733-3259
Mailing Address - Country:US
Mailing Address - Phone:607-621-2053
Mailing Address - Fax:607-320-4073
Practice Address - Street 1:243 CORBIN RD
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:NY
Practice Address - Zip Code:13733-3259
Practice Address - Country:US
Practice Address - Phone:607-621-2053
Practice Address - Fax:607-320-4073
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY287398164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse