Provider Demographics
NPI:1851564306
Name:WILMES, JEANNINE (ND, EAMP)
Entity Type:Individual
Prefix:DR
First Name:JEANNINE
Middle Name:
Last Name:WILMES
Suffix:
Gender:F
Credentials:ND, EAMP
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 252
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-0252
Mailing Address - Country:US
Mailing Address - Phone:360-794-1456
Mailing Address - Fax:
Practice Address - Street 1:4033 STONE WAY N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8011
Practice Address - Country:US
Practice Address - Phone:206-486-2031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001649175F00000X
WAAC60018053171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist