Healthcare Provider Details

I. General information

NPI: 1164878922
Provider Name (Legal Business Name): NWA HEARING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 HALSTED CIR SIUTE C
ROGERS AR
72756-3185
US

IV. Provider business mailing address

11 HALSTED CIR SIUTE C
ROGERS AR
72756-3185
US

V. Phone/Fax

Practice location:
  • Phone: 479-372-4883
  • Fax:
Mailing address:
  • Phone: 479-372-4883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number595
License Number StateAR

VIII. Authorized Official

Name: DEEANN MARIE IOVINELLI
Title or Position: OWNER
Credential: BC-HIS, ACA
Phone: 479-372-4883