Healthcare Provider Details

I. General information

NPI: 1659033033
Provider Name (Legal Business Name): SANOS ANTI-AGING MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 E MERRITT ST STE C
PRESCOTT AZ
86301-2027
US

IV. Provider business mailing address

172 E MERRITT ST STE C
PRESCOTT AZ
86301-2027
US

V. Phone/Fax

Practice location:
  • Phone: 928-224-2813
  • Fax:
Mailing address:
  • Phone: 928-224-2813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: DR. EMILIE WILSON
Title or Position: OWNER, CLINICIAN
Credential: ND, LAC
Phone: 928-224-2813