Provider Demographics
NPI:1417568486
Name:WADE, JENNIFER CHENG (ND, EAMP)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:CHENG
Last Name:WADE
Suffix:
Gender:F
Credentials:ND, EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 SEAVIEW AVE NW STE 160
Mailing Address - Street 2:PMB 563
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-6021
Mailing Address - Country:US
Mailing Address - Phone:408-621-5787
Mailing Address - Fax:
Practice Address - Street 1:4100 ESTATE SION FARM STE 16 AND 17
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:408-621-5787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2022-10-14
Deactivation Date:2020-08-17
Deactivation Code:
Reactivation Date:2022-10-03
Provider Licenses
StateLicense IDTaxonomies
WAAC61083743171100000X
WA175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist