Provider Demographics
NPI:1891287553
Name:JARRETT, JAMIE (LPN)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:JARRETT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 BLUEBERRY CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23868-3218
Mailing Address - Country:US
Mailing Address - Phone:646-246-4729
Mailing Address - Fax:
Practice Address - Street 1:311 BLUEBERRY CT
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:VA
Practice Address - Zip Code:23868-3218
Practice Address - Country:US
Practice Address - Phone:646-246-4729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002087680164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse