Provider Demographics
NPI:1447822176
Name:FELDT, JAMIE HARRELL (RN)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:HARRELL
Last Name:FELDT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6041 OTTERBEIN LN APT 204
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-7597
Mailing Address - Country:US
Mailing Address - Phone:610-762-4554
Mailing Address - Fax:
Practice Address - Street 1:6041 OTTERBEIN LN APT 204
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-7597
Practice Address - Country:US
Practice Address - Phone:610-762-4554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1052107163W00000X
MDR243978163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse