Provider Demographics
NPI:1013514991
Name:AVENA INTEGRATIVE MEDICINE
Entity Type:Organization
Organization Name:AVENA INTEGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:RENNER
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LAC
Authorized Official - Phone:802-238-4174
Mailing Address - Street 1:453 STONE CUTTERS WAY
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-4431
Mailing Address - Country:US
Mailing Address - Phone:802-238-4174
Mailing Address - Fax:
Practice Address - Street 1:453 STONE CUTTERS WAY
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-4431
Practice Address - Country:US
Practice Address - Phone:802-238-4174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-05
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty