Provider Demographics
NPI:1902511025
Name:STELLARIA NATURAL MEDICINE
Entity Type:Organization
Organization Name:STELLARIA NATURAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HYDE
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:207-756-3303
Mailing Address - Street 1:229 AVENIDA MIRADOR
Mailing Address - Street 2:
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-9408
Mailing Address - Country:US
Mailing Address - Phone:207-756-3303
Mailing Address - Fax:
Practice Address - Street 1:2900 HILLRISE DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4702
Practice Address - Country:US
Practice Address - Phone:575-305-3441
Practice Address - Fax:575-305-3445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM52970884Medicaid