Healthcare Provider Details

I. General information

NPI: 1467832410
Provider Name (Legal Business Name): SARA SUPINSKI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 MAIN AVE, SUITE 240
DURANGO CO
81301
US

IV. Provider business mailing address

1998 COUNTY ROAD 205
DURANGO CO
81301
US

V. Phone/Fax

Practice location:
  • Phone: 719-660-6526
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SARA SUPINSKI
Title or Position: ACUPUNCTURIST
Credential: L.A.C.
Phone: 719-660-6526