Healthcare Provider Details

I. General information

NPI: 1356780761
Provider Name (Legal Business Name): WHITNEY SARAH HORSTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1532 CERRILLOS RD STE C
SANTA FE NM
87505-3512
US

IV. Provider business mailing address

PO BOX 22902
SANTA FE NM
87502-2902
US

V. Phone/Fax

Practice location:
  • Phone: 505-986-9109
  • Fax:
Mailing address:
  • Phone: 808-280-9962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1034
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number8437
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number7589
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1118
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: