Provider Demographics
NPI:1114075355
Name:NEVELS, JENNIFER CONOVER (ND)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CONOVER
Last Name:NEVELS
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 1:2039 E GEMINI DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3317
Mailing Address - Country:US
Mailing Address - Phone:480-227-9669
Mailing Address - Fax:
Practice Address - Street 1:5416 E SOUTHERN AVE # 109
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3622
Practice Address - Country:US
Practice Address - Phone:480-985-0000
Practice Address - Fax:480-985-0029
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ03760175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath