Healthcare Provider Details

I. General information

NPI: 1073720272
Provider Name (Legal Business Name): PATRICIA LYNN WISMANN-HORTHER M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7065 S ELM CT
CENTENNIAL CO
80122-2459
US

IV. Provider business mailing address

7065 S ELM CT
CENTENNIAL CO
80122-2459
US

V. Phone/Fax

Practice location:
  • Phone: 720-220-9335
  • Fax: 720-489-6062
Mailing address:
  • Phone: 720-220-9335
  • Fax: 720-489-6062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number0203172
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: