Healthcare Provider Details

I. General information

NPI: 1184148967
Provider Name (Legal Business Name): ERICA H ALTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 SW 3RD AVE APT 505
MIAMI FL
33129-2048
US

IV. Provider business mailing address

6700 WASHINGTON AVE S
EDEN PRAIRIE MN
55344-3405
US

V. Phone/Fax

Practice location:
  • Phone: 561-866-6309
  • Fax:
Mailing address:
  • Phone: 612-351-1529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY2122
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAY2122
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAY2122
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberCA3411
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: