Healthcare Provider Details

I. General information

NPI: 1770710519
Provider Name (Legal Business Name): HANNAH FOGG N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2009
Last Update Date: 06/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 WASHINGTON AVE
PORTLAND ME
04101-2632
US

IV. Provider business mailing address

218 WASHINGTON AVE
PORTLAND ME
04101-2632
US

V. Phone/Fax

Practice location:
  • Phone: 207-653-9993
  • Fax:
Mailing address:
  • Phone: 207-653-9993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNP333
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: