Provider Demographics
NPI:1023531316
Name:SMOLKO, JAMIE STEIN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:STEIN
Last Name:SMOLKO
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 CHESTER ST # 2
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-3032
Mailing Address - Country:US
Mailing Address - Phone:919-672-5102
Mailing Address - Fax:
Practice Address - Street 1:200 N GREENSBORO ST STE C6
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-1849
Practice Address - Country:US
Practice Address - Phone:919-962-4919
Practice Address - Fax:919-445-0414
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009673363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health