Healthcare Provider Details

I. General information

NPI: 1699242750
Provider Name (Legal Business Name): CARRIE TENELLE DENNIE ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2018
Last Update Date: 10/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 FULTON ST W
GRAND RAPIDS MI
49504-6313
US

IV. Provider business mailing address

126 WOODWIND CIR
KALAMAZOO MI
49006-4163
US

V. Phone/Fax

Practice location:
  • Phone: 616-264-6556
  • Fax:
Mailing address:
  • Phone: 517-896-4312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number099.0134066
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: