Provider Demographics
NPI:1215669379
Name:ALLEN, JAIMIE (MSN, FNP-BC)
Entity type:Individual
Prefix:
First Name:JAIMIE
Middle Name:
Last Name:ALLEN
Suffix:
Gender:
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43592 CHAMPLAIN CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1711
Mailing Address - Country:US
Mailing Address - Phone:814-572-2190
Mailing Address - Fax:
Practice Address - Street 1:2300 HAGGERTY RD STE 2070
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2190
Practice Address - Country:US
Practice Address - Phone:248-926-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704341683363LX0001X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology