Provider Demographics
NPI:1932687431
Name:STREETER, JAIME (RN)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:STREETER
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 1:42 SHERWOOD PL
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-5633
Mailing Address - Country:US
Mailing Address - Phone:203-661-2440
Mailing Address - Fax:203-552-5276
Practice Address - Street 1:42 SHERWOOD PL
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5633
Practice Address - Country:US
Practice Address - Phone:203-661-2440
Practice Address - Fax:203-552-5276
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT66690163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice