Healthcare Provider Details

I. General information

NPI: 1013198555
Provider Name (Legal Business Name): SAMANTHA KANE EAGLE N.D., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 05/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 MAIN ST 2ND FLOOR, SUITE 4
BRATTLEBORO VT
05301-2867
US

IV. Provider business mailing address

205 MAIN ST 2ND FLOOR, SUITE 4
BRATTLEBORO VT
05301-2867
US

V. Phone/Fax

Practice location:
  • Phone: 802-275-4732
  • Fax: 802-275-4738
Mailing address:
  • Phone: 802-275-4732
  • Fax: 802-275-4738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number099-0000215
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: