Healthcare Provider Details

I. General information

NPI: 1689641763
Provider Name (Legal Business Name): NICOLE L JAMIESON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 TURF LANE
EAST LANSING MI
48823-6392
US

IV. Provider business mailing address

1560 TURF LANE
EAST LANSING MI
48823-6392
US

V. Phone/Fax

Practice location:
  • Phone: 517-484-3000
  • Fax: 517-484-6358
Mailing address:
  • Phone: 517-484-3000
  • Fax: 517-484-6358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number4704194361
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: