Provider Demographics
NPI:1033407960
Name:VIRES, JENNIFER HERINGER (EAMC, LAC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HERINGER
Last Name:VIRES
Suffix:
Gender:F
Credentials:EAMC, LAC
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:VIRES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REV
Mailing Address - Street 1:17705 88TH AVE NE # B
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-1822
Mailing Address - Country:US
Mailing Address - Phone:206-434-9870
Mailing Address - Fax:
Practice Address - Street 1:17705 88TH AVE NE # B
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-1822
Practice Address - Country:US
Practice Address - Phone:206-434-9870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60216977171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist