Provider Demographics
NPI:1275076556
Name:GUMBS-TYLER, LORIE (ND, CNS)
Entity Type:Individual
Prefix:DR
First Name:LORIE
Middle Name:
Last Name:GUMBS-TYLER
Suffix:
Gender:F
Credentials:ND, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-5844
Mailing Address - Country:US
Mailing Address - Phone:917-545-8122
Mailing Address - Fax:
Practice Address - Street 1:33 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-5844
Practice Address - Country:US
Practice Address - Phone:917-545-8122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-18
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT586175F00000X
MDJ00064175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath