Provider Demographics
NPI:1063906105
Name:TOMILO, JAMIE (LPN, CLC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:TOMILO
Suffix:
Gender:F
Credentials:LPN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 MILFORD ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14220-1615
Mailing Address - Country:US
Mailing Address - Phone:716-803-0769
Mailing Address - Fax:
Practice Address - Street 1:4575 MAIN ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-4567
Practice Address - Country:US
Practice Address - Phone:716-633-4575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN