Provider Demographics
NPI:1396140166
Name:SZKODZINSKI, JAMIE LEIGH (PA-C)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEIGH
Last Name:SZKODZINSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LEIGH
Other - Last Name:BRAWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:17877 W 14 MILE RD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-3127
Mailing Address - Country:US
Mailing Address - Phone:248-644-3920
Mailing Address - Fax:248-644-2569
Practice Address - Street 1:17877 W 14 MILE RD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-3127
Practice Address - Country:US
Practice Address - Phone:248-644-3920
Practice Address - Fax:248-644-2569
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007216363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant