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General NPI Number Information
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NPI Number | 1295036648
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Entity Type | Organization
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Legal Business Name | NATURE SOURCE CARE
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Dates
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Enumeration Date | 11/16/2010
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Last Update Date | 11/16/2010
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Provider Practice Location Address
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Address Line | 2505 MAIN ST STE 209B
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City | STRATFORD
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State | CT
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Zip | 06615-5813
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Country | US
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Telephone | 203-895-5534
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Fax |
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Provider Business Mailing Address
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Address Line | 65 RIVER RD
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City | NORTH HAVEN
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State | CT
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Zip | 06473-4344
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | FUNDA GULMEN
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Credential |
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Telephone | 203-895-5534
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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 | 399
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License Number State | CT
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