Healthcare Provider Details

I. General information

NPI: 1619232659
Provider Name (Legal Business Name): SARA BULSON ND, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 12/26/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1532 E DRIFTWOOD DR
TEMPE AZ
85283-2113
US

IV. Provider business mailing address

1532 E DRIFTWOOD DR
TEMPE AZ
85283-2113
US

V. Phone/Fax

Practice location:
  • Phone: 303-818-9575
  • Fax: 480-992-9311
Mailing address:
  • Phone: 303-818-9575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number23-1795
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number13679
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: