Provider Demographics
NPI:1578917852
Name:WHITNEY, JADE (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4917 S TUNE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-8846
Mailing Address - Country:US
Mailing Address - Phone:480-695-1491
Mailing Address - Fax:
Practice Address - Street 1:4917 S TUNE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-8846
Practice Address - Country:US
Practice Address - Phone:480-695-1491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-22
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0842171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist