Provider Demographics
NPI:1255756466
Name:WAY, JASON RYAN (ND)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:RYAN
Last Name:WAY
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 BLUE RAVINE RD
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-4748
Mailing Address - Country:US
Mailing Address - Phone:916-351-9355
Mailing Address - Fax:
Practice Address - Street 1:230 BLUE RAVINE RD
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4748
Practice Address - Country:US
Practice Address - Phone:916-351-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND632175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath