Healthcare Provider Details

I. General information

NPI: 1871208165
Provider Name (Legal Business Name): JAMIE WREDE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 01/20/2023
Certification Date: 01/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4313 E SMOKEHOUSE TRL
CAVE CREEK AZ
85331-5024
US

IV. Provider business mailing address

4313 E SMOKEHOUSE TRL
CAVE CREEK AZ
85331-5024
US

V. Phone/Fax

Practice location:
  • Phone: 480-636-6590
  • Fax:
Mailing address:
  • Phone: 480-636-6590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number253494
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: