MEDICARE: SARAH ELIZABETH HARTWIG LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	1122	AZ

General Provider Information

NPI Number	:	1104322775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH ELIZABETH HARTWIG LAC

Provider Business Mailing Address
First Line	:	1470 S PALO VERDE AVE APT J212
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85713-2397
Country	:	US
Telephone Number	:	503-580-5669
Fax Number	:

Provider Business Practice Location Address
First Line	:	1470 S PALO VERDE AVE APT J212
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85713-2397
Country	:	US
Telephone Number	:	503-580-5669
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2018
Last Update Date	:	04/03/2018

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