Provider Demographics
NPI:1679025969
Name:POINDEXTER, JENNIFER (ND)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:POINDEXTER
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 1:22127 S TONYA CT
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OR
Mailing Address - Zip Code:97004-9665
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18813 SW MARTINAZZI AVE STE UNIT
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-6807
Practice Address - Country:US
Practice Address - Phone:503-765-5265
Practice Address - Fax:503-725-3222
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4028175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath