Provider Demographics
NPI:1194150284
Name:ITO, JENNIFER ELLEN (ND)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ELLEN
Last Name:ITO
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 1:1235 ONSLOW RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-1925
Mailing Address - Country:US
Mailing Address - Phone:919-780-4163
Mailing Address - Fax:
Practice Address - Street 1:1235 ONSLOW RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-1925
Practice Address - Country:US
Practice Address - Phone:919-854-2735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-07
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099.0000242175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath