Healthcare Provider Details

I. General information

NPI: 1801245303
Provider Name (Legal Business Name): JAMI A CLINE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 S MADISON DR
TEMPE AZ
85281-7248
US

IV. Provider business mailing address

618 S MADISON DR
TEMPE AZ
85281-7248
US

V. Phone/Fax

Practice location:
  • Phone: 480-784-1514
  • Fax:
Mailing address:
  • Phone: 480-784-1514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN142330
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP8735
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: