Provider Demographics
NPI:1407284441
Name:SMITH, JENNIFER LYNN (NMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:SMITH
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 1:3841 E MONTE CRISTO AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4034
Mailing Address - Country:US
Mailing Address - Phone:480-529-7348
Mailing Address - Fax:
Practice Address - Street 1:16421 N TATUM BLVD STE 210
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3454
Practice Address - Country:US
Practice Address - Phone:602-675-0170
Practice Address - Fax:602-675-1735
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-30
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13-1375175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath