Provider Demographics
NPI:1851907208
Name:GETTYS, JAMIE (RN, BSN, CBS)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:GETTYS
Suffix:
Gender:F
Credentials:RN, BSN, CBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 N 400 E APT 4
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-3040
Mailing Address - Country:US
Mailing Address - Phone:916-871-0363
Mailing Address - Fax:
Practice Address - Street 1:339 N 400 E APT 4
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-3040
Practice Address - Country:US
Practice Address - Phone:916-871-0363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10226301-3102163WM0102X, 163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn