Provider Demographics
NPI:1922312511
Name:POTTER, JENNIFER MANNING (ND)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MANNING
Last Name:POTTER
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:LOUISE
Other - Last Name:MANNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND
Mailing Address - Street 1:1707 WHITHAM AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5328
Mailing Address - Country:US
Mailing Address - Phone:650-388-0710
Mailing Address - Fax:
Practice Address - Street 1:744 SAN ANTONIO RD
Practice Address - Street 2:SUITE 1
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-4632
Practice Address - Country:US
Practice Address - Phone:650-388-0710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND414175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath