Provider Demographics
NPI:1699980227
Name:PLEWA, JAIME MELINDA (ARNP)
Entity type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:MELINDA
Last Name:PLEWA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3516 12TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5218
Mailing Address - Country:US
Mailing Address - Phone:360-918-0604
Mailing Address - Fax:360-456-6504
Practice Address - Street 1:3516 12TH AVE NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5218
Practice Address - Country:US
Practice Address - Phone:360-918-0604
Practice Address - Fax:360-456-6504
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007039363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9653551Medicaid
WA9653551Medicaid