MEDICARE: JAMIE MCMULLEN FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	4704267881	MI

General Provider Information

NPI Number	:	1194519892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE MCMULLEN FNP

Provider Business Mailing Address
First Line	:	629 E COMSTOCK ST
Second Line	:
City	:	OWOSSO
State	:	MI
Zip	:	48867-3201
Country	:	US
Telephone Number	:	989-743-0383
Fax Number	:

Provider Business Practice Location Address
First Line	:	4028 STATE ST
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48603-4070
Country	:	US
Telephone Number	:	989-341-6006
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2025
Last Update Date	:	04/07/2025

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