Provider Demographics
NPI:1831256361
Name:SULLWOLD, JAMIE MARIE (MA)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:MARIE
Last Name:SULLWOLD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:MARIE
Other - Last Name:CONNORS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:634 S 233RD LN
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-4066
Mailing Address - Country:US
Mailing Address - Phone:602-510-6631
Mailing Address - Fax:
Practice Address - Street 1:924 N COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-4108
Practice Address - Country:US
Practice Address - Phone:480-969-3800
Practice Address - Fax:480-834-7003
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician