Provider Demographics
NPI:1902106438
Name:WORRELL, JAMIE L (RN)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:L
Last Name:WORRELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:JAMIE
Other - Middle Name:L
Other - Last Name:WAKELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:310 W SUNNYVIEW DR
Mailing Address - Street 2:APT 103
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-3866
Mailing Address - Country:US
Mailing Address - Phone:414-217-3828
Mailing Address - Fax:
Practice Address - Street 1:310 W SUNNYVIEW DR
Practice Address - Street 2:APT 103
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-3866
Practice Address - Country:US
Practice Address - Phone:414-217-3828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI170975-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse