Provider Demographics
NPI:1124385810
Name:STILLMAN, SARAH WHITE (LAC, MSOM)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:WHITE
Last Name:STILLMAN
Suffix:
Gender:F
Credentials:LAC, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 TABLE MESA DR
Mailing Address - Street 2:STE. 205
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-5869
Mailing Address - Country:US
Mailing Address - Phone:970-708-1576
Mailing Address - Fax:
Practice Address - Street 1:3400 TABLE MESA DR
Practice Address - Street 2:STE. 205
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-5869
Practice Address - Country:US
Practice Address - Phone:303-499-9395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2015-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1768171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist