Provider Demographics
NPI:1508307760
Name:WELLSPRING, SAMANTHA AAYLAH (ND)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:AAYLAH
Last Name:WELLSPRING
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 COUNTY ROAD 502
Mailing Address - Street 2:
Mailing Address - City:BAYFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81122-9006
Mailing Address - Country:US
Mailing Address - Phone:970-769-2494
Mailing Address - Fax:
Practice Address - Street 1:2421 COUNTY ROAD 502
Practice Address - Street 2:
Practice Address - City:BAYFIELD
Practice Address - State:CO
Practice Address - Zip Code:81122-9006
Practice Address - Country:US
Practice Address - Phone:970-769-2494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COND.0000146175F00000X
OR4051175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath