Provider Demographics
NPI:1659033033
Name:SANOS ANTI-AGING MEDICINE
Entity Type:Organization
Organization Name:SANOS ANTI-AGING MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LAC
Authorized Official - Phone:928-224-2813
Mailing Address - Street 1:172 E MERRITT ST STE C
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-2027
Mailing Address - Country:US
Mailing Address - Phone:928-224-2813
Mailing Address - Fax:
Practice Address - Street 1:172 E MERRITT ST STE C
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-2027
Practice Address - Country:US
Practice Address - Phone:928-224-2813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty