Provider Demographics
NPI:1114478906
Name:SMITHERS, JILLIAN ASHLEY (NMD)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:ASHLEY
Last Name:SMITHERS
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 E CAMELBACK RD
Mailing Address - Street 2:SUITE 126
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4424
Mailing Address - Country:US
Mailing Address - Phone:480-747-5559
Mailing Address - Fax:480-483-6604
Practice Address - Street 1:2929 E CAMELBACK RD
Practice Address - Street 2:SUITE 126
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4424
Practice Address - Country:US
Practice Address - Phone:480-747-5559
Practice Address - Fax:480-483-6604
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16-1569175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ175F00000XOtherNATUROPATH