Provider Demographics
NPI:1265964258
Name:JAMISON, PAIGE MARIE (NP)
Entity type:Individual
Prefix:MRS
First Name:PAIGE
Middle Name:MARIE
Last Name:JAMISON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:PAIGE
Other - Middle Name:MARIE
Other - Last Name:JAMISON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PAIGEMARIENP
Mailing Address - Street 1:680 QUIMBY RD
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-9573
Mailing Address - Country:US
Mailing Address - Phone:260-316-0652
Mailing Address - Fax:
Practice Address - Street 1:601 E CHICAGO RD
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-8130
Practice Address - Country:US
Practice Address - Phone:517-462-6267
Practice Address - Fax:517-781-7169
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704266663363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care