Provider Demographics
NPI:1194246223
Name:OSTDIEK, JAMIE (PA-C)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:OSTDIEK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:S
Other - Last Name:JARECKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1908 E VAUGHN ST
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-4226
Mailing Address - Country:US
Mailing Address - Phone:480-421-9010
Mailing Address - Fax:
Practice Address - Street 1:7505 S MCCLINTOCK DR STE 103
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-5042
Practice Address - Country:US
Practice Address - Phone:480-755-1000
Practice Address - Fax:480-755-0011
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2335363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical