Provider Demographics
NPI:1689275604
Name:PATEL, JAMIE (CNP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 211639
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-3639
Mailing Address - Country:US
Mailing Address - Phone:888-897-1887
Mailing Address - Fax:857-343-8192
Practice Address - Street 1:260 ARSENAL PL
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-3171
Practice Address - Country:US
Practice Address - Phone:888-897-1887
Practice Address - Fax:857-343-8192
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1181481363LF0000X
MARN2332663363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily