Organization
EARTH SOURCE MEDICINE
Active
Other names
Astoria Integrative Family Medicine, Naturopathic By Design
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CAROLYN IACULLO NYGAARD (OWNER)
(207) 209-4858
Entity
Organization
Contact information
Practice address
757 W MARINE DR STE 103, ASTORIA, OR 97103-5848
(207) 209-4858
(207) 405-2199
Mailing address
757 W MARINE DR STE 103, ASTORIA, OR 97103-5848
(207) 209-4858
(207) 405-2199
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
OR
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500642404
—
OR
Enumeration date
06/19/2017
Last updated
04/21/2026
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