Provider Demographics
NPI:1184175218
Name:MARKHAM, JENNIFER (ND)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:MARKHAM
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 1:9927 W MESCALERO CT
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85373-1115
Mailing Address - Country:US
Mailing Address - Phone:720-600-7533
Mailing Address - Fax:
Practice Address - Street 1:501 W RAY RD STE 4
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-7284
Practice Address - Country:US
Practice Address - Phone:480-999-4230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COND.0000139175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
COND.0000139OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES