Provider Demographics
NPI:1851544621
Name:OMANN, JAMIE LAURICH (RN, CPNP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LAURICH
Last Name:OMANN
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:LAURICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2497 7TH AVENUE E
Mailing Address - Street 2:SUITE 108
Mailing Address - City:NORTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2946
Mailing Address - Country:US
Mailing Address - Phone:651-769-6437
Mailing Address - Fax:651-769-6599
Practice Address - Street 1:2497 7TH AVENUE E
Practice Address - Street 2:SUITE 108
Practice Address - City:NORTH ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-2946
Practice Address - Country:US
Practice Address - Phone:651-769-6437
Practice Address - Fax:651-769-6599
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR157357-8363LP0200X
MN397363LP0200X
MN1573578363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics