Provider Demographics
NPI:1316976681
Name:JAMIESON, MAUREEN (CRNA)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:JAMIESON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3002
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-0302
Mailing Address - Country:US
Mailing Address - Phone:360-414-2048
Mailing Address - Fax:360-575-6749
Practice Address - Street 1:1615 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2310
Practice Address - Country:US
Practice Address - Phone:360-636-4878
Practice Address - Fax:360-414-7457
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00151767163W00000X
WAAP30006617367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR213398Medicaid
WA9640129Medicaid
WA8943329OtherCRIME VICTIMS
WA0196021OtherLABOR & IND
OR213398Medicaid
WA8860624Medicare PIN