Provider Demographics
NPI:1033209762
Name:EVERETT, JENNIFER CHEN (LAC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CHEN
Last Name:EVERETT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 TRANCAS ST
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2903
Mailing Address - Country:US
Mailing Address - Phone:707-226-5393
Mailing Address - Fax:707-226-5335
Practice Address - Street 1:901 TRANCAS ST
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2903
Practice Address - Country:US
Practice Address - Phone:707-226-5393
Practice Address - Fax:707-226-5335
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9832171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist