Provider Demographics
NPI:1043406986
Name:EWALD, JAIME S (NMD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:S
Last Name:EWALD
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1277 E MISSOURI AVE STE 114
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2916
Mailing Address - Country:US
Mailing Address - Phone:602-293-3939
Mailing Address - Fax:602-283-5726
Practice Address - Street 1:1277 E MISSOURI AVE STE 114
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2916
Practice Address - Country:US
Practice Address - Phone:602-293-3939
Practice Address - Fax:022-835-7266
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ06-960175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath