Healthcare Provider Details

I. General information

NPI: 1114672276
Provider Name (Legal Business Name): DAYNA YVONNE JONDAL NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N BISHOP AVE APT 469
DALLAS TX
75208-1361
US

IV. Provider business mailing address

200 N BISHOP AVE APT 469
DALLAS TX
75208-1361
US

V. Phone/Fax

Practice location:
  • Phone: 507-440-3127
  • Fax:
Mailing address:
  • Phone: 507-440-3127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number735439295
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: