Healthcare Provider Details

I. General information

NPI: 1619246360
Provider Name (Legal Business Name): EGNARO AUDIOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2011
Last Update Date: 12/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 MELLON ST
LITTLE ROCK AR
72207-6150
US

IV. Provider business mailing address

1412 MELLON ST
LITTLE ROCK AR
72207-6150
US

V. Phone/Fax

Practice location:
  • Phone: 501-837-3337
  • Fax:
Mailing address:
  • Phone: 501-837-3337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA238
License Number StateAR

VIII. Authorized Official

Name: DR. LISA CHRISTENSEN
Title or Position: VP
Credential: AU.D.
Phone: 501-529-9980