Basic Information
Provider Information
NPI: 1033557616
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KIMBALL
FirstName: JEANA
MiddleName: DENISE
NamePrefix: DR.
NameSuffix:  
Credential: ND, MPH
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
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
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
175F00000X00000626WAY Other Service ProvidersNaturopath 
175F00000X000035PRN Other Service ProvidersNaturopath 

No ID Information.


Home