Healthcare Provider Details

I. General information

NPI: 1902511025
Provider Name (Legal Business Name): STELLARIA NATURAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 HILLRISE DR
LAS CRUCES NM
88011-4702
US

IV. Provider business mailing address

229 AVENIDA MIRADOR
SANTA TERESA NM
88008-9408
US

V. Phone/Fax

Practice location:
  • Phone: 575-305-3441
  • Fax: 575-305-3445
Mailing address:
  • Phone: 207-756-3303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SARA HYDE
Title or Position: OWNER/PHYSICIAN
Credential: ND
Phone: 207-756-3303