Healthcare Provider Details

I. General information

NPI: 1104085687
Provider Name (Legal Business Name): NICOLE R KERR N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

857 N MAIN STREET EXT STE 2
WALLINGFORD CT
06492-2465
US

IV. Provider business mailing address

857 N MAIN STREET EXT STE 2
WALLINGFORD CT
06492-2465
US

V. Phone/Fax

Practice location:
  • Phone: 203-265-0444
  • Fax:
Mailing address:
  • Phone: 203-265-0444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number000389
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: