Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 16-1571 | AZ |
NPI | 1124562517 |
---|---|
Provider Name | Miss Jade Robins |
First Address | Payson, AZ 85541-2675 |
Second Address | Fairbanks, AK 99709-5234 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2016 |
Last Update Date | 05/12/2016 |