Provider Demographics
NPI:1750684163
Name:JENZER, AMADEA (ND)
Entity type:Individual
Prefix:
First Name:AMADEA
Middle Name:
Last Name:JENZER
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 1:7711 NE 175TH ST APT F206
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-6500
Mailing Address - Country:US
Mailing Address - Phone:425-420-6180
Mailing Address - Fax:
Practice Address - Street 1:5603 230TH ST SW
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-4617
Practice Address - Country:US
Practice Address - Phone:425-697-6112
Practice Address - Fax:425-697-3252
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60188376175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath