Basic Information
| Provider Information | |||||||||
| NPI: | 1033557616 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIMBALL | ||||||||
| FirstName: | JEANA | ||||||||
| MiddleName: | DENISE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ND, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 509 OLIVE WAY STE 1315 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981011771 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2068517300 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 509 OLIVE WAY STE 1315 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981011771 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063829977 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2013 | ||||||||
| LastUpdateDate: | 09/29/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 175F00000X | 000035 | PR | N | Other Service Providers | Naturopath | 175F00000X | 00000626 | WA | Y | Other Service Providers | Naturopath |
No ID Information.