Provider Demographics
NPI:1710575741
Name:CORE, JAMIE LYNNE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNNE
Last Name:CORE
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LYNNE
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:960 N 16TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-4175
Mailing Address - Country:US
Mailing Address - Phone:541-744-8660
Mailing Address - Fax:541-744-8460
Practice Address - Street 1:960 N 16TH ST STE 104
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-4175
Practice Address - Country:US
Practice Address - Phone:541-744-8660
Practice Address - Fax:541-744-8460
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL-302065163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant