Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 03760 | AZ |
NPI | 1114075355 |
---|---|
Provider Name | Jennifer Conover Nevels |
First Address | Tempe, AZ 85283-3317 |
Second Address | Mesa, AZ 85206-3622 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2007 |
Last Update Date | 08/07/2007 |