Provider Demographics
NPI:1487157798
Name:LOPES, JAIME LYN (PHD)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:LYN
Last Name:LOPES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JAIME
Other - Middle Name:LYN
Other - Last Name:STAFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:68 W FERRY ST APT 5
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3638
Mailing Address - Country:US
Mailing Address - Phone:248-872-7279
Mailing Address - Fax:
Practice Address - Street 1:200 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-0001
Practice Address - Country:US
Practice Address - Phone:507-284-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program