Healthcare Provider Details

I. General information

NPI: 1437154218
Provider Name (Legal Business Name): IRENA RENATA RDZANEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 TRAIL BLVD STE 16
NAPLES FL
34108-2860
US

IV. Provider business mailing address

190 ESTRELLITA DR
FT MYERS BEACH FL
33931-5204
US

V. Phone/Fax

Practice location:
  • Phone: 239-566-2727
  • Fax: 239-463-7149
Mailing address:
  • Phone: 239-463-7149
  • Fax: 239-463-7149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAY77
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: