Provider Demographics
NPI:1891976304
Name:LEWANDOWSKI, JAMIE ARNETT (PAC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:ARNETT
Last Name:LEWANDOWSKI
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N WILLOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-9462
Mailing Address - Country:US
Mailing Address - Phone:517-279-9599
Mailing Address - Fax:517-279-1679
Practice Address - Street 1:410 N WILLOWBROOK RD
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-9462
Practice Address - Country:US
Practice Address - Phone:517-279-9599
Practice Address - Fax:517-279-1679
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1095363A00000X
OH50002705363A00000X
MI5601006971363A00000X
IN363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH089970Medicare PIN