Provider Demographics
NPI:1528276045
Name:TETA, JADE ANTHONY (ND)
Entity type:Individual
Prefix:DR
First Name:JADE
Middle Name:ANTHONY
Last Name:TETA
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5200 BEAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-9603
Mailing Address - Country:US
Mailing Address - Phone:336-413-3761
Mailing Address - Fax:877-886-3348
Practice Address - Street 1:114 REYNOLDA VLG
Practice Address - Street 2:SUITE L
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-5131
Practice Address - Country:US
Practice Address - Phone:336-724-4452
Practice Address - Fax:877-886-3348
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001357175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath