Provider Demographics
NPI:1851603187
Name:JAMISON, DIONNE LYNETTA (RN)
Entity Type:Individual
Prefix:MS
First Name:DIONNE
Middle Name:LYNETTA
Last Name:JAMISON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5520 NORTHFORD RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45426-1108
Mailing Address - Country:US
Mailing Address - Phone:937-529-4501
Mailing Address - Fax:
Practice Address - Street 1:2931 LOUELLA AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-4215
Practice Address - Country:US
Practice Address - Phone:937-263-0583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH136492164W00000X
OH429490163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3101119Medicaid
OH429490Medicaid