Healthcare Provider Details

I. General information

NPI: 1053430934
Provider Name (Legal Business Name): MRS. DELLA LATINA VANHORN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 JOHNSON AVE N
TALLADEGA AL
35160-2464
US

IV. Provider business mailing address

75 HONEYSUCKLE WAY
RIVERSIDE AL
35135-1025
US

V. Phone/Fax

Practice location:
  • Phone: 256-362-7716
  • Fax: 256-362-7715
Mailing address:
  • Phone: 205-352-4690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2168
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: