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General NPI Number Information
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NPI Number | 1104343235
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Entity Type | Individual
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Provider Name | RICHARD ROBERT JAMIE APRN, CNP
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Gender | Male
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Dates
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Enumeration Date | 08/29/2017
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Last Update Date | 08/14/2024
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Provider Practice Location Address
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Address Line | 635 N DEARBORN ST STE 100
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City | CHICAGO
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State | IL
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Zip | 60654-4618
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Country | US
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Telephone | 312-694-2273
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Fax | 312-694-2129
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Provider Business Mailing Address
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Address Line | 635 N DEARBORN ST STE 100
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City | CHICAGO
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State | IL
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Zip | 60654-4618
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Country | US
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Telephone | 312-694-2273
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Fax | 312-694-2129
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 71013534A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 3011300
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CNP.020842
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 277003302
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License Number State | IL
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