Healthcare Provider Details

I. General information

NPI: 1386171114
Provider Name (Legal Business Name): PAULINE CROUCH N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SEROYA CROUCH N.D.

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 11/23/2024
Certification Date: 11/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 MAIN ST LEVEL 2
PUTNEY VT
05346
US

IV. Provider business mailing address

PO BOX 355
PUTNEY VT
05346-0355
US

V. Phone/Fax

Practice location:
  • Phone: 802-387-0124
  • Fax: 802-387-3970
Mailing address:
  • Phone: 802-387-0124
  • Fax: 802-419-3790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number639
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number099.0129466
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: