Healthcare Provider Details

I. General information

NPI: 1275076556
Provider Name (Legal Business Name): LORIE GUMBS-TYLER ND, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2016
Last Update Date: 07/02/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 RIDGE AVE
BRIDGEPORT CT
06604-5844
US

IV. Provider business mailing address

33 RIDGE AVE
BRIDGEPORT CT
06604-5844
US

V. Phone/Fax

Practice location:
  • Phone: 917-545-8122
  • Fax:
Mailing address:
  • Phone: 917-545-8122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number586
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberJ00064
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: