Healthcare Provider Details

I. General information

NPI: 1356922496
Provider Name (Legal Business Name): JAMIE L BASO MSN , PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE L SCHANILEC MSN , PMHNP-BC

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 FORD RD STE B
ST LOUIS PARK MN
55426-1115
US

IV. Provider business mailing address

4240 PARK GLEN RD
ST LOUIS PARK MN
55416-5427
US

V. Phone/Fax

Practice location:
  • Phone: 952-378-1800
  • Fax: 952-378-1714
Mailing address:
  • Phone: 612-925-6033
  • Fax: 612-925-8496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number8138
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: