Provider Demographics
NPI:1588144745
Name:MADEIRA, JAMI LYNN
Entity type:Individual
Prefix:
First Name:JAMI
Middle Name:LYNN
Last Name:MADEIRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 CAMBRIA AVENUE
Mailing Address - Street 2:APARTMENT 7
Mailing Address - City:REVLOC
Mailing Address - State:PA
Mailing Address - Zip Code:15948
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 LAKEMONT PARK BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-5967
Practice Address - Country:US
Practice Address - Phone:814-946-0261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator