Healthcare Provider Details

I. General information

NPI: 1851740021
Provider Name (Legal Business Name): KATHLEEN MYERS HAD6180
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 S LA CANADA DR STE 3
GREEN VALLEY AZ
85622-3325
US

IV. Provider business mailing address

1451 S LA CANADA DR STE 3
GREEN VALLEY AZ
85622-3325
US

V. Phone/Fax

Practice location:
  • Phone: 520-444-5552
  • Fax:
Mailing address:
  • Phone: 520-444-5552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberHAD6180
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAD6180
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: