Provider Demographics
NPI:1811151392
Name:VADER, JAMIE LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:VADER
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LYNN
Other - Last Name:WAGENER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12650 W 64TH AVE UNIT E501
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-3893
Mailing Address - Country:US
Mailing Address - Phone:303-431-4127
Mailing Address - Fax:303-431-4553
Practice Address - Street 1:12650 W 64TH AVE UNIT E501
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-3893
Practice Address - Country:US
Practice Address - Phone:303-431-4127
Practice Address - Fax:303-431-4553
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0002606363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical