Healthcare Provider Details

I. General information

NPI: 1194908277
Provider Name (Legal Business Name): GRASSHOPPER NATURAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 PASEO DE PERALTA
SANTA FE NM
87501-1860
US

IV. Provider business mailing address

PO BOX 6628
ALBUQUERQUE NM
87197
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-2449
  • Fax: 505-986-6005
Mailing address:
  • Phone: 505-501-2701
  • Fax: 505-986-6005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DAWN VIVIAN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 505-988-2449