Provider Demographics
NPI:1518418649
Name:RIEGLE, JENNIFER (ND)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:
Last Name:RIEGLE
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 576
Mailing Address - Street 2:
Mailing Address - City:VALLEY FORD
Mailing Address - State:CA
Mailing Address - Zip Code:94972-0576
Mailing Address - Country:US
Mailing Address - Phone:253-376-6604
Mailing Address - Fax:
Practice Address - Street 1:431 HUMBOLDT ST
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4287
Practice Address - Country:US
Practice Address - Phone:707-243-8998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND827175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath