Provider Demographics
NPI:1821366642
Name:OLTMANN, JAMIE LYNNE
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNNE
Last Name:OLTMANN
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 1:320 W BREMER AVE
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-3102
Mailing Address - Country:US
Mailing Address - Phone:319-596-1085
Mailing Address - Fax:319-596-1091
Practice Address - Street 1:320 W BREMER AVE
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-3102
Practice Address - Country:US
Practice Address - Phone:319-596-1085
Practice Address - Fax:319-596-1091
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21329183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist