Provider Demographics
NPI:1497185623
Name:KOOIMA, JESSICA (NMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:KOOIMA
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 1:3547 E LIBERTY LN
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-7365
Mailing Address - Country:US
Mailing Address - Phone:712-470-3876
Mailing Address - Fax:
Practice Address - Street 1:1355 S HIGLEY RD STE 111
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4799
Practice Address - Country:US
Practice Address - Phone:480-988-2181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-25
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13-1390175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath