MEDICARE: WHITNEY SARAH HORSTMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	1034	HI
2	172M00000X	Mechanotherapist	8437	HI
3	172M00000X	Mechanotherapist	7589	NM
4	171100000X	Acupuncturist	1118	NM

General Provider Information

NPI Number	:	1356780761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WHITNEY SARAH HORSTMAN

Provider Business Mailing Address
First Line	:	PO BOX 22902
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87502-2902
Country	:	US
Telephone Number	:	808-280-9962
Fax Number	:

Provider Business Practice Location Address
First Line	:	1532 CERRILLOS RD STE C
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-3512
Country	:	US
Telephone Number	:	505-986-9109
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2013
Last Update Date	:	02/18/2014

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