Provider Demographics
NPI:1083866461
Name:SAILER, ELIZABETH TUCKER (LAC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:TUCKER
Last Name:SAILER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7095 E HURLBUT AVE
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-2667
Mailing Address - Country:US
Mailing Address - Phone:707-228-8102
Mailing Address - Fax:
Practice Address - Street 1:820 GRAVENSTEIN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4557
Practice Address - Country:US
Practice Address - Phone:707-228-8102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5009171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist