Provider Demographics
NPI:1053986307
Name:BARNWELL, JAMIE WAGNER (DO)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:WAGNER
Last Name:BARNWELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MUNSON FAMILY PRACTICE CENTER
Mailing Address - Street 2:1400 MEDICAL CAMPUS DRIVE
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684
Mailing Address - Country:US
Mailing Address - Phone:231-935-8012
Mailing Address - Fax:
Practice Address - Street 1:MUNSON FAMILY PRACTICE CENTER
Practice Address - Street 2:1400 MEDICAL CAMPUS DRIVE
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684
Practice Address - Country:US
Practice Address - Phone:231-935-8012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI5101027776207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program