Provider Demographics
NPI:1316101314
Name:LANDSVERK, JAMIE LEE (FNP-BC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEE
Last Name:LANDSVERK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LEE
Other - Last Name:HARNDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:PO BOX 3428
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62708-3428
Mailing Address - Country:US
Mailing Address - Phone:217-588-6140
Mailing Address - Fax:
Practice Address - Street 1:901 W MORTON AVE STE 22
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-4021
Practice Address - Country:US
Practice Address - Phone:217-588-6140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007133363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041334217OtherRN