MEDICARE: SARAH C. GRANT

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	1038	NM

General Provider Information

NPI Number	:	1588952477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH C. GRANT

Provider Business Mailing Address
First Line	:	836 PABLINA ST
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-1054
Country	:	US
Telephone Number	:	505-992-1963
Fax Number	:

Provider Business Practice Location Address
First Line	:	3816 CARLISLE BLVD NE STE B
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-4547
Country	:	US
Telephone Number	:	505-837-2335
Fax Number	:

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

Provider Enumeration Date	:	07/13/2011
Last Update Date	:	07/13/2011

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