Provider Demographics
NPI:1083752117
Name:PETERSON, JENA MARIE (ND)
Entity Type:Individual
Prefix:DR
First Name:JENA
Middle Name:MARIE
Last Name:PETERSON
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 1:2008 NE 65TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-6934
Mailing Address - Country:US
Mailing Address - Phone:206-729-0907
Mailing Address - Fax:206-729-0199
Practice Address - Street 1:2008 NE 65TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-6934
Practice Address - Country:US
Practice Address - Phone:206-729-0907
Practice Address - Fax:206-729-0199
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1313175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath