Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175F00000X | Naturopath | 12-1298 | AZ |
Y | 175F00000X | Naturopath | ND870 | CA |
NPI | 1033463740 |
---|---|
Provider Name | Dr. La Deana L Jeane |
First Address | Sebastopol, CA 95472-4465 |
Second Address | Santa Rosa, CA 95401-4671 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2012 |
Last Update Date | 07/12/2019 |