Healthcare Provider Details

I. General information

NPI: 1780940916
Provider Name (Legal Business Name): YOUR NATURAL DR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2452 BLACK ROCK TPKE STE 7
FAIRFIELD CT
06825-2407
US

IV. Provider business mailing address

30 WILLOW ST
MILFORD CT
06460-6348
US

V. Phone/Fax

Practice location:
  • Phone: 203-549-1511
  • Fax: 203-690-1522
Mailing address:
  • Phone: 203-500-9191
  • Fax: 203-783-9016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number000556
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number000476
License Number StateCT

VIII. Authorized Official

Name: DR. MICHELLE ANN HESSBERGER
Title or Position: OWNER
Credential: ND, LAC
Phone: 203-500-9191