Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 16-1569 | AZ |
NPI | 1114478906 |
---|---|
Provider Name | Dr. Jillian Ashley Smithers |
First Address | Phoenix, AZ 85016-4424 |
Second Address | Phoenix, AZ 85016-4424 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2016 |
Last Update Date | 17/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
175F00000X | NATUROPATH (01) | AZ |