Provider Demographics
NPI:1306124417
Name:STAFFORD, JAMIE RAE (LDEM)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:RAE
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:LDEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 454
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714
Mailing Address - Country:US
Mailing Address - Phone:406-600-1896
Mailing Address - Fax:
Practice Address - Street 1:569 MILLIGAN CANYON RD
Practice Address - Street 2:
Practice Address - City:CARDWELL
Practice Address - State:MT
Practice Address - Zip Code:59721
Practice Address - Country:US
Practice Address - Phone:406-600-1896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT34176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife