Healthcare Provider Details

I. General information

NPI: 1073221453
Provider Name (Legal Business Name): MEREDITH BRIELLE AISTRUP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6607 BRODIE LN APT 434
AUSTIN TX
78745-4650
US

IV. Provider business mailing address

6607 BRODIE LN APT 434
AUSTIN TX
78745-4650
US

V. Phone/Fax

Practice location:
  • Phone: 913-832-9263
  • Fax:
Mailing address:
  • Phone: 913-832-9263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number22-1757
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: