Provider Demographics
NPI:1013198555
Name:EAGLE, SAMANTHA KANE (ND, MS)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:KANE
Last Name:EAGLE
Suffix:
Gender:F
Credentials:ND, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:205 MAIN ST
Mailing Address - Street 2:2ND FLOOR, SUITE 4
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-2867
Mailing Address - Country:US
Mailing Address - Phone:802-275-4732
Mailing Address - Fax:802-275-4738
Practice Address - Street 1:205 MAIN ST
Practice Address - Street 2:2ND FLOOR, SUITE 4
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-2867
Practice Address - Country:US
Practice Address - Phone:802-275-4732
Practice Address - Fax:802-275-4738
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099-0000215175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath