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General NPI Number Information
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NPI Number | 1588908412
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Entity Type | Individual
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Provider Name | SARA A SUPINSKI L.A.C.
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Gender | Female
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 06/17/2020
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Provider Practice Location Address
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Address Line | 34 500 E SUITE 202
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City | SALT LAKE CITY
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State | UT
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Zip | 84102
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Country | US
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Telephone | 801-582-2011
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Fax |
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Provider Business Mailing Address
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Address Line | 58 W QUAYLE AVE
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City | SOUTH SALT LAKE
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State | UT
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Zip | 84115-1975
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Country | US
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Telephone | 719-660-6526
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 11269775-1201
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License Number State | UT
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