Provider Demographics
NPI:1790983609
Name:LONGHURST, JAMIE LYNN (DO)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:LONGHURST
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LYNN
Other - Last Name:LONGHURST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:800 INDUSTRIAL RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1743
Mailing Address - Country:US
Mailing Address - Phone:517-490-1216
Mailing Address - Fax:269-233-5265
Practice Address - Street 1:800 INDUSTRIAL RD
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1743
Practice Address - Country:US
Practice Address - Phone:517-490-1216
Practice Address - Fax:269-233-5265
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017343207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine