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General NPI Number Information
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NPI Number | 1376028480
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Entity Type | Individual
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Provider Name | KARISSA RAE DEANE ND
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Gender | Female
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Dates
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Enumeration Date | 09/25/2018
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 254 COMMERCIAL STREET STE 258
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City | PORTLAND
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State | ME
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Zip | 04101-4664
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Country | US
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Telephone | 207-705-5138
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Fax |
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Provider Business Mailing Address
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Address Line | 254 COMMERCIAL STREET STE 258
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City | PORTLAND
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State | ME
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Zip | 04101-4664
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Country | US
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Telephone | 802-349-2959
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | NP700
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License Number State | ME
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