Healthcare Provider Details

I. General information

NPI: 1083369300
Provider Name (Legal Business Name): JENNIFER ELIZABETH AREVALO NBCHWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 02/15/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10106 WINSTEAD LN
CINCINNATI OH
45231-2718
US

IV. Provider business mailing address

10106 WINSTEAD LN
CINCINNATI OH
45231-2718
US

V. Phone/Fax

Practice location:
  • Phone: 941-962-2765
  • Fax:
Mailing address:
  • Phone: 941-962-2765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3339523
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: