Provider Demographics
NPI:1699928952
Name:JEWELL-LARSON, JENNIFER LYNN TAM (ND)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN TAM
Last Name:JEWELL-LARSON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:TAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND
Mailing Address - Street 1:1688 WILLOW STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125
Mailing Address - Country:US
Mailing Address - Phone:408-356-1364
Mailing Address - Fax:408-462-6431
Practice Address - Street 1:1688 WILLOW STREET
Practice Address - Street 2:SUITE C
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125
Practice Address - Country:US
Practice Address - Phone:408-356-1364
Practice Address - Fax:408-462-6431
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2023-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-328175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath