MEDICARE: DR. KARISSA RAE DEANE ND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175F00000X	Naturopath
2	175F00000X	Naturopath	NP700	ME

General Provider Information

NPI Number	:	1376028480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARISSA RAE DEANE ND

Provider Business Mailing Address
First Line	:	254 COMMERCIAL STREET STE 258
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04101-4664
Country	:	US
Telephone Number	:	802-349-2959
Fax Number	:

Provider Business Practice Location Address
First Line	:	254 COMMERCIAL STREET STE 258
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04101-4664
Country	:	US
Telephone Number	:	207-705-5138
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2018
Last Update Date	:	12/04/2025

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