Healthcare Provider Details

I. General information

NPI: 1477567063
Provider Name (Legal Business Name): JAMIE M HAIN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2980 BELMONT AVE
YOUNGSTOWN OH
44505-1834
US

IV. Provider business mailing address

2980 BELMONT AVE
YOUNGSTOWN OH
44505-1834
US

V. Phone/Fax

Practice location:
  • Phone: 330-759-2310
  • Fax: 330-759-0018
Mailing address:
  • Phone: 330-759-2310
  • Fax: 330-759-0018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN173920
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN173920
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCOA.06522-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: