Healthcare Provider Details

I. General information

NPI: 1245962257
Provider Name (Legal Business Name): JONATHAN ERIC STIRN AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1727 BOYSON RD
HIAWATHA IA
52233-2313
US

IV. Provider business mailing address

1727 BOYSON RD
HIAWATHA IA
52233-2313
US

V. Phone/Fax

Practice location:
  • Phone: 319-393-2796
  • Fax: 319-393-4782
Mailing address:
  • Phone: 319-393-2796
  • Fax: 319-393-4782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number108607
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number108607
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number115046
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: