Healthcare Provider Details

I. General information

NPI: 1376883124
Provider Name (Legal Business Name): MERCEDES MICHELLE KUETTEL H.I.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 02/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4632 E GERMANN RD 1064
GILBERT AZ
85297-8362
US

IV. Provider business mailing address

4632 E GERMANN RD 1064
GILBERT AZ
85297-8362
US

V. Phone/Fax

Practice location:
  • Phone: 480-331-9254
  • Fax:
Mailing address:
  • Phone: 480-331-9254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAD5864
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: