Healthcare Provider Details

I. General information

NPI: 1093183659
Provider Name (Legal Business Name): RICHARD WEATHERBY N.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 GROUT RD
HARTLAND VT
05048-9606
US

IV. Provider business mailing address

32 GROUT RD
HARTLAND VT
05048-9606
US

V. Phone/Fax

Practice location:
  • Phone: 802-436-1003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number099.0117249
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: