Healthcare Provider Details

I. General information

NPI: 1831226083
Provider Name (Legal Business Name): ELEANOR LORRAINE WILSON AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 CALIFORNIA AVENUE SUITE 203
BAKERSFIELD CA
93309-0711
US

IV. Provider business mailing address

5000 CALIFORNIA AVENUE SUITE 203
BAKERSFIELD CA
93309-0711
US

V. Phone/Fax

Practice location:
  • Phone: 661-323-2601
  • Fax: 661-323-2627
Mailing address:
  • Phone: 661-323-2601
  • Fax: 661-323-2627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAU1586
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: