Healthcare Provider Details

I. General information

NPI: 1669628541
Provider Name (Legal Business Name): KARA NOEL FITZGERALD ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 GLEN RD 4TH FLOOR
SANDY HOOK CT
06482-1193
US

IV. Provider business mailing address

27 GLEN RD 4TH FLOOR
SANDY HOOK CT
06482-1193
US

V. Phone/Fax

Practice location:
  • Phone: 203-304-9502
  • Fax: 203-304-9503
Mailing address:
  • Phone: 203-304-9502
  • Fax: 203-304-9503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1463
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number000403
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: