Provider Demographics
NPI:1376028480
Name:DEANE, KARISSA RAE (ND)
Entity type:Individual
Prefix:DR
First Name:KARISSA
Middle Name:RAE
Last Name:DEANE
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 1:254 COMMERCIAL STREET STE 258
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-4664
Mailing Address - Country:US
Mailing Address - Phone:802-349-2959
Mailing Address - Fax:
Practice Address - Street 1:254 COMMERCIAL STREET STE 258
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4664
Practice Address - Country:US
Practice Address - Phone:207-705-5138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-25
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175F00000X
MENP700175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath