Provider Demographics
NPI:1629841606
Name:EAKES, JENNIFER LYNN (NBHWC, RYT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:EAKES
Suffix:
Gender:F
Credentials:NBHWC, RYT
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:EAKES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:424 N GENESEE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-2245
Mailing Address - Country:US
Mailing Address - Phone:917-992-2893
Mailing Address - Fax:
Practice Address - Street 1:424 N GENESEE AVE STE 1
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-2245
Practice Address - Country:US
Practice Address - Phone:917-992-2893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach