Healthcare Provider Details

I. General information

NPI: 1205508652
Provider Name (Legal Business Name): EMMA DURIVAGE AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 N HAYDEN RD STE E102
SCOTTSDALE AZ
85258-2589
US

IV. Provider business mailing address

750 N COMMONS DR STE 200
AURORA IL
60504-7940
US

V. Phone/Fax

Practice location:
  • Phone: 480-305-2033
  • Fax: 480-305-2034
Mailing address:
  • Phone: 630-303-5380
  • Fax: 630-303-5385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberDA13444
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: