Provider Demographics
NPI:1902382005
Name:JANE, ASHLEE (NMD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEE
Middle Name:
Last Name:JANE
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 N 9TH ST STE 205D
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5781
Mailing Address - Country:US
Mailing Address - Phone:208-391-5003
Mailing Address - Fax:208-908-0035
Practice Address - Street 1:202 N 9TH ST STE 205D
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5781
Practice Address - Country:US
Practice Address - Phone:208-391-5003
Practice Address - Fax:208-908-0035
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-12
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4165175F00000X
IDNMD-0017175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath