Provider Demographics
NPI:1740530500
Name:WOTELL, JAIMIE (PA)
Entity type:Individual
Prefix:MRS
First Name:JAIMIE
Middle Name:
Last Name:WOTELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:1306 CONCOURSE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM
Mailing Address - State:MD
Mailing Address - Zip Code:21090-1033
Mailing Address - Country:US
Mailing Address - Phone:443-351-3376
Mailing Address - Fax:410-431-8935
Practice Address - Street 1:231 NAJOLES RD STE 300
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-2659
Practice Address - Country:US
Practice Address - Phone:443-351-3376
Practice Address - Fax:443-494-2303
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC0004840363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical