MEDICARE: JAMIE ULLMARK CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	406484	NY

General Provider Information

NPI Number	:	1366534463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE ULLMARK CRNA

Provider Business Mailing Address
First Line	:	1305 WALT WHITMAN RD STE 300
Second Line	:
City	:	MELVILLE
State	:	NY
Zip	:	11747-4300
Country	:	US
Telephone Number	:	516-945-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	529 CENTRAL AVE
Second Line	:
City	:	DUNKIRK
State	:	NY
Zip	:	14048-2514
Country	:	US
Telephone Number	:	716-366-1111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	06/26/2026

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