Healthcare Provider Details

I. General information

NPI: 1588952477
Provider Name (Legal Business Name): SARAH C. GRANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 07/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3816 CARLISLE BLVD NE STE B
ALBUQUERQUE NM
87107-4547
US

IV. Provider business mailing address

836 PABLINA ST
SANTA FE NM
87505-1054
US

V. Phone/Fax

Practice location:
  • Phone: 505-837-2335
  • Fax:
Mailing address:
  • Phone: 505-992-1963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1038
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: