Provider Demographics
NPI:1780030916
Name:HATFIELD, JADE
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JADE
Other - Middle Name:
Other - Last Name:DANDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ND
Mailing Address - Street 1:7660 HORSESHOE BEND RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-3800
Mailing Address - Country:US
Mailing Address - Phone:208-939-6748
Mailing Address - Fax:
Practice Address - Street 1:7660 HORSESHOE BEND RD
Practice Address - Street 2:SUITE D
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-3800
Practice Address - Country:US
Practice Address - Phone:208-939-6748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath