Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 18-1728 | AZ |
NPI | 1134603475 |
---|---|
Provider Name | Jacob Hyrum Shettell |
First Address | Mesa, AZ 85201-6314 |
Second Address | Chandler, AZ 85224-5719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2018 |
Last Update Date | 22/09/2018 |