| Doctor Name: | MS. JAIME ANN SUNDSTROM |
| NPI Number: | 1639196496 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CRNP |
| License Number: | SP007142 |
| Business Practice Address: | 951 Male Rd Blue Valley Family Practice Wind Gap, PA - 180911513 |
| Business Phone Number: | 6106541000 |
| Business Fax Number: | 6106542004 |
| Mailing Address: | 951 Male Rd, Blue Valley Family Practice WIND GAP |
| State: | PA |
| Postal Code: | 180911513 |
| Phone Number: | 6106541000 |
| Fax Number: | 6106542004 |
| NPI Enumeration Date: | 07/17/2006 |
| NPI Last Update Date: | 03/04/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | SP007142 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |