Healthcare Provider Details

I. General information

NPI: 1962675660
Provider Name (Legal Business Name): NANCY TARA DENIRO AUDIOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 W SAINT MARYS RD STE 211
TUCSON AZ
85745-2696
US

IV. Provider business mailing address

1775 W SAINT MARYS RD STE 211
TUCSON AZ
85745-2696
US

V. Phone/Fax

Practice location:
  • Phone: 520-792-2170
  • Fax: 520-792-9702
Mailing address:
  • Phone: 520-792-2170
  • Fax: 520-792-9702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberDA1175
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: