Provider Demographics
NPI:1679804686
Name:MCMAINS, JAMIE J (VN203316)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:J
Last Name:MCMAINS
Suffix:
Gender:F
Credentials:VN203316
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 CLEVELAND AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4282
Mailing Address - Country:US
Mailing Address - Phone:707-576-0818
Mailing Address - Fax:707-576-7845
Practice Address - Street 1:1901 CLEVELAND AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4282
Practice Address - Country:US
Practice Address - Phone:707-576-0818
Practice Address - Fax:707-576-7845
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN203316164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse