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General NPI Number Information
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NPI Number | 1508307760
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Entity Type | Individual
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Provider Name | SAMANTHA AAYLAH WELLSPRING ND
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Gender | Female
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Dates
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Enumeration Date | 03/20/2017
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Last Update Date | 09/26/2023
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Provider Practice Location Address
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Address Line | 2421 COUNTY ROAD 502
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City | BAYFIELD
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State | CO
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Zip | 81122-9006
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Country | US
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Telephone | 970-769-2494
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Fax |
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Provider Business Mailing Address
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Address Line | 2421 COUNTY ROAD 502
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City | BAYFIELD
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State | CO
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Zip | 81122-9006
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Country | US
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Telephone | 970-769-2494
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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 | ND.0000146
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License Number State | CO
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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 | 4051
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License Number State | OR
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