Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath |
NPI | 1053680793 |
---|---|
Provider Name | Dr. Sarah Stout |
First Address | Ballston Lake, NY 12019-2241 |
Second Address | Ballston Lake, NY 12019-2241 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2011 |
Last Update Date | 25/09/2014 |