Provider Demographics
NPI:1275268179
Name:CHRISTIAN, SARAH TATUM (LAC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:TATUM
Last Name:CHRISTIAN
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 1:188 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:08801-3512
Mailing Address - Country:US
Mailing Address - Phone:434-851-2685
Mailing Address - Fax:
Practice Address - Street 1:270 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NJ
Practice Address - Zip Code:08833-4218
Practice Address - Country:US
Practice Address - Phone:908-236-9499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-24
Last Update Date:2022-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007136171100000X
NJ25MZ00162000171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist