Provider Demographics
NPI:1760267884
Name:WIENTJES, JAMIE MARIE
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:MARIE
Last Name:WIENTJES
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 1:3232 N 27TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7443
Mailing Address - Country:US
Mailing Address - Phone:805-377-2178
Mailing Address - Fax:
Practice Address - Street 1:3232 N 27TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7443
Practice Address - Country:US
Practice Address - Phone:805-377-2178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ264404163WN0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0800XNursing Service ProvidersRegistered NurseNeuroscience