Provider Demographics
NPI:1518313048
Name:RAYACHOTI, JENNA MARIE (ND)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:RAYACHOTI
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:MARIE
Other - Last Name:DILLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND
Mailing Address - Street 1:PO BOX 254
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:WA
Mailing Address - Zip Code:98862-0254
Mailing Address - Country:US
Mailing Address - Phone:307-699-2787
Mailing Address - Fax:
Practice Address - Street 1:45 CASSAL RD
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:WA
Practice Address - Zip Code:98862-9134
Practice Address - Country:US
Practice Address - Phone:307-699-2787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANATU.NT.60655893175F00000X
WA60655893175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath