Provider Demographics
NPI:1174297972
Name:PRONATURAL WELLNESS GROUP LLC
Entity Type:Organization
Organization Name:PRONATURAL WELLNESS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:OPOKU GYAMFI
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:860-830-9796
Mailing Address - Street 1:1265 BERLIN TPKE UNIT B
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-3228
Mailing Address - Country:US
Mailing Address - Phone:860-829-0707
Mailing Address - Fax:
Practice Address - Street 1:1265 BERLIN TPKE UNIT B
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037-3228
Practice Address - Country:US
Practice Address - Phone:860-829-0707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty