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General NPI Number Information
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NPI Number | 1003304627
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Entity Type | Organization
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Legal Business Name | OPEN HEART HOLISTIC HEALTH LLC
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Dates
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Enumeration Date | 04/30/2018
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Last Update Date | 04/30/2018
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Provider Practice Location Address
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Address Line | 133 STATE ST
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City | GUILFORD
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State | CT
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Zip | 06437-2471
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Country | US
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Telephone | 203-689-2585
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Fax | 844-203-9936
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Provider Business Mailing Address
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Address Line | 133 STATE ST
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City | GUILFORD
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State | CT
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Zip | 06437-2471
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Country | US
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Telephone | 203-689-2585
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ELISE PANZA
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Credential | ND
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Telephone | 203-605-6760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 000529
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License Number State | CT
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