Provider Demographics
NPI:1831303668
Name:RODRIGUEZ, JAMIE LYNN (WHNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LYNN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:WHNP-PC
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Mailing Address - Street 1:555 MIDTOWNE STREET NE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-5731
Mailing Address - Country:US
Mailing Address - Phone:616-588-1200
Mailing Address - Fax:616-588-1250
Practice Address - Street 1:555 MIDTOWNE STREET NE
Practice Address - Street 2:SUITE 400
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-5731
Practice Address - Country:US
Practice Address - Phone:616-588-1200
Practice Address - Fax:616-588-1250
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2011-06-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704228492363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P53200019Medicare PIN