Healthcare Provider Details

I. General information

NPI: 1801102645
Provider Name (Legal Business Name): NOSOMA AUDIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 08/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2902 GINNALA DR STE 3
LOVELAND CO
80538-7818
US

IV. Provider business mailing address

2902 GINNALA DR STE 3
LOVELAND CO
80538-7818
US

V. Phone/Fax

Practice location:
  • Phone: 970-593-1509
  • Fax: 970-593-6810
Mailing address:
  • Phone: 970-593-1509
  • Fax: 970-593-6810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number461
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number461
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number461
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number461
License Number StateCO

VIII. Authorized Official

Name: MS. CYNTHIA SUE VIGIL
Title or Position: AUDIOLOGIST
Credential: M.A.
Phone: 970-593-1509