Healthcare Provider Details

I. General information

NPI: 1790296127
Provider Name (Legal Business Name): DESTINY GREEN ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 S RIVER RD UNIT 10057
BEDFORD NH
03110-9717
US

IV. Provider business mailing address

25 S RIVER RD UNIT 10057
BEDFORD NH
03110-9717
US

V. Phone/Fax

Practice location:
  • Phone: 603-660-7428
  • Fax:
Mailing address:
  • Phone: 603-660-7428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number0005
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: