Provider Demographics
NPI:1831851419
Name:AMICK, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:AMICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 PINOT NOIR DR
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-7408
Mailing Address - Country:US
Mailing Address - Phone:209-715-4814
Mailing Address - Fax:
Practice Address - Street 1:716 PINOT NOIR DR
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-7408
Practice Address - Country:US
Practice Address - Phone:209-715-4814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide