Provider Demographics
NPI:1306434246
Name:GOHDE, JAMIE (FNP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:GOHDE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 ELLISON LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SOLON SPRINGS
Mailing Address - State:WI
Mailing Address - Zip Code:54873-4760
Mailing Address - Country:US
Mailing Address - Phone:715-817-6809
Mailing Address - Fax:
Practice Address - Street 1:3415 ELLISON LAKE RD
Practice Address - Street 2:
Practice Address - City:SOLON SPRINGS
Practice Address - State:WI
Practice Address - Zip Code:54873-4760
Practice Address - Country:US
Practice Address - Phone:715-817-6809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10468363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily