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General NPI Number Information
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NPI Number | 1942511589
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Entity Type | Organization
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Legal Business Name | NORTHSTAR NATURAL MEDICINE LLC
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Dates
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Enumeration Date | 06/29/2010
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Last Update Date | 06/29/2010
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Provider Practice Location Address
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Address Line | 35 BOSTON ST
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City | GUILFORD
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State | CT
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Zip | 06437-2817
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Country | US
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Telephone | 203-980-8003
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Fax |
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Provider Business Mailing Address
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Address Line | 391 S UNION ST
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City | GUILFORD
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State | CT
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Zip | 06437-2824
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Country | US
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Telephone | 203-980-8003
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Fax | 203-980-8003
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. KRISTIE A FERREIRA
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Credential | N.D.
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Telephone | 203-980-8003
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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 | 000414
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License Number State | CT
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