Provider Demographics
NPI:1184934994
Name:WIMBERLEY, JADE (ND)
Entity type:Individual
Prefix:DR
First Name:JADE
Middle Name:
Last Name:WIMBERLEY
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 1:304 HILLCREST DRIVE
Mailing Address - Street 2:APARTMENT 203
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301
Mailing Address - Country:US
Mailing Address - Phone:970-759-9733
Mailing Address - Fax:
Practice Address - Street 1:304 HILLCREST DR
Practice Address - Street 2:APARTMENT 203
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-6508
Practice Address - Country:US
Practice Address - Phone:970-759-9733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT65446908-7199175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath