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NPI Code Detail

MEDICARE: JILL WYANT AUD

MEDICARE: JILL WYANT AUD
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
1237600000XAudiologist-Hearing Aid Fitter119-ANV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1801994991
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL WYANT AUD
Provider Business Mailing Address
First Line : 6850 N DURANGO DR STE 314
Second Line :
City : LAS VEGAS
State : NV
Zip : 89149-4598
Country : US
Telephone Number : 702-834-5886
Fax Number : 702-834-5752
Provider Business Practice Location Address
First Line : 6850 N DURANGO DR STE 314
Second Line :
City : LAS VEGAS
State : NV
Zip : 89149-4598
Country : US
Telephone Number : 702-834-5886
Fax Number : 702-834-5752
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 05/02/2019

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