Provider Demographics
NPI:1306279997
Name:MASHBURN, JAMIE A (RN)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:A
Last Name:MASHBURN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:JAMIE
Other - Middle Name:A
Other - Last Name:RADUENZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1825 PARAMOUNT DR
Mailing Address - Street 2:UNIT H
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-3948
Mailing Address - Country:US
Mailing Address - Phone:414-526-3791
Mailing Address - Fax:
Practice Address - Street 1:1825 PARAMOUNT DR
Practice Address - Street 2:UNIT H
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-3948
Practice Address - Country:US
Practice Address - Phone:414-526-3791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163756-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse