Provider Demographics
NPI:1033463740
Name:JEANE, LA DEANA L (ND)
Entity Type:Individual
Prefix:DR
First Name:LA DEANA
Middle Name:L
Last Name:JEANE
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7197 LYNCH RD
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4465
Mailing Address - Country:US
Mailing Address - Phone:337-208-5476
Mailing Address - Fax:
Practice Address - Street 1:1160 N DUTTON AVE STE 260
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4671
Practice Address - Country:US
Practice Address - Phone:707-292-8882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2019-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12-1298175F00000X
CAND870175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath