Provider Demographics
NPI:1861546822
Name:POULIOT, MICHELLE JEAN (ND)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:JEAN
Last Name:POULIOT
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 1:536 MAIN ST
Mailing Address - Street 2:PO BOX 72
Mailing Address - City:NEW HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06057-2108
Mailing Address - Country:US
Mailing Address - Phone:860-238-7983
Mailing Address - Fax:860-239-7985
Practice Address - Street 1:536 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06057-2108
Practice Address - Country:US
Practice Address - Phone:860-238-7983
Practice Address - Fax:860-239-7985
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT136175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath