MEDICARE: MADISON ELIZABETH BRESETT AU.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	A-1095	WY

General Provider Information

NPI Number	:	1457180788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON ELIZABETH BRESETT AU.D.

Provider Business Mailing Address
First Line	:	3513 RANDY RD
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82001-5974
Country	:	US
Telephone Number	:	315-323-6765
Fax Number	:

Provider Business Practice Location Address
First Line	:	7215 COMMONS CIR UNIT C
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82009-2666
Country	:	US
Telephone Number	:	307-426-4327
Fax Number	:	307-426-3277

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2024
Last Update Date	:	07/26/2024

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