Healthcare Provider Details

I. General information

NPI: 1568082972
Provider Name (Legal Business Name): TRISTIAN ROWE NATUROPATHIC DOCTOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2020
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

884 BROADWAY STE 9
SOUTH PORTLAND ME
04106-4371
US

IV. Provider business mailing address

884 BROADWAY STE 9
SOUTH PORTLAND ME
04106-4371
US

V. Phone/Fax

Practice location:
  • Phone: 207-319-6207
  • Fax: 207-618-7402
Mailing address:
  • Phone: 207-319-6207
  • Fax: 207-618-7402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNP677
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: