Provider Demographics
NPI:1356922496
Name:BASO, JAMIE L (MSN , PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:BASO
Suffix:
Gender:F
Credentials:MSN , PMHNP-BC
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:L
Other - Last Name:SCHANILEC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN , PMHNP-BC
Mailing Address - Street 1:4240 PARK GLEN RD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5427
Mailing Address - Country:US
Mailing Address - Phone:612-925-6033
Mailing Address - Fax:612-925-8496
Practice Address - Street 1:1155 FORD RD STE B
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-1115
Practice Address - Country:US
Practice Address - Phone:952-378-1800
Practice Address - Fax:952-378-1714
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8138363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health