Provider Demographics
NPI:1205041209
Name:STURM, SIMONE ALEXANDRA (LAC, DAOM)
Entity Type:Individual
Prefix:
First Name:SIMONE
Middle Name:ALEXANDRA
Last Name:STURM
Suffix:
Gender:F
Credentials:LAC, DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 ELATI STREET
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204
Mailing Address - Country:US
Mailing Address - Phone:303-862-8756
Mailing Address - Fax:720-358-6008
Practice Address - Street 1:1235 ELATI STREET
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204
Practice Address - Country:US
Practice Address - Phone:303-862-8756
Practice Address - Fax:720-358-6008
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1464171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist