Healthcare Provider Details

I. General information

NPI: 1023467503
Provider Name (Legal Business Name): JAMIE BRICKLEY MILLER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE BRICKEY MASSARELLI FNP-C

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 HIGH STREET
SPRINGFIELD MA
01105-1442
US

IV. Provider business mailing address

280 CHESTNUT STREET 2ND FLOOR
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-2515
  • Fax: 413-794-5673
Mailing address:
  • Phone: 413-794-7552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2341944
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: