Provider Demographics
NPI:1548738289
Name:NOURISHING LIFE
Entity Type:Organization
Organization Name:NOURISHING LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:EASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:631-403-7689
Mailing Address - Street 1:10 STATION CT
Mailing Address - Street 2:
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-2453
Mailing Address - Country:US
Mailing Address - Phone:631-681-2580
Mailing Address - Fax:
Practice Address - Street 1:10 STATION CT
Practice Address - Street 2:
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713-2453
Practice Address - Country:US
Practice Address - Phone:631-403-7689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-12
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service