Provider Demographics
NPI:1710150123
Name:ADKINS WORKMAN, JAMIE FU
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:FU
Last Name:ADKINS WORKMAN
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 1:10117 US HIGHWAY 62
Mailing Address - Street 2:LOT 21
Mailing Address - City:ORIENT
Mailing Address - State:OH
Mailing Address - Zip Code:43146-9700
Mailing Address - Country:US
Mailing Address - Phone:614-622-7454
Mailing Address - Fax:
Practice Address - Street 1:10117 US HIGHWAY 62
Practice Address - Street 2:LOT 21
Practice Address - City:ORIENT
Practice Address - State:OH
Practice Address - Zip Code:43146-9700
Practice Address - Country:US
Practice Address - Phone:614-622-7454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN110641164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2354170Medicaid