Healthcare Provider Details

I. General information

NPI: 1831668672
Provider Name (Legal Business Name): KRISTA IMRE ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2018
Last Update Date: 02/01/2025
Certification Date: 02/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 COMMERCIAL ST STE 258
PORTLAND ME
04101-4664
US

IV. Provider business mailing address

254 COMMERCIAL ST STE 258
PORTLAND ME
04101-4664
US

V. Phone/Fax

Practice location:
  • Phone: 561-571-3326
  • Fax: 207-405-2199
Mailing address:
  • Phone:
  • Fax: 207-405-2199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: