Provider Demographics
NPI:1376749382
Name:JANKOWITZ, NAOMI L (LAC, MSOM)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:L
Last Name:JANKOWITZ
Suffix:
Gender:F
Credentials:LAC, MSOM
Other - Prefix:
Other - First Name:NAOMI
Other - Middle Name:JANKOWITZ
Other - Last Name:BROWNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC, MSOM
Mailing Address - Street 1:4219 EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-2036
Mailing Address - Country:US
Mailing Address - Phone:208-947-5840
Mailing Address - Fax:
Practice Address - Street 1:4219 EMERALD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-2036
Practice Address - Country:US
Practice Address - Phone:208-947-5840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDACU-160171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist