Provider Demographics
NPI:1356600134
Name:JIMENEZ, LAURA (ND)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22405 SE 287TH PL
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-3302
Mailing Address - Country:US
Mailing Address - Phone:360-890-8421
Mailing Address - Fax:
Practice Address - Street 1:22405 SE 287TH PL
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-3302
Practice Address - Country:US
Practice Address - Phone:360-890-8421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175F00000X
WANT60285540175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath