Healthcare Provider Details

I. General information

NPI: 1487079802
Provider Name (Legal Business Name): CHRISTIE BURNETT ANDERSON M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2014
Last Update Date: 06/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 S RIVER ST
HAILEY ID
83333-8436
US

IV. Provider business mailing address

1415 PARKVIEW DR STE 100
TWIN FALLS ID
83301-3250
US

V. Phone/Fax

Practice location:
  • Phone: 208-788-0296
  • Fax: 208-788-9679
Mailing address:
  • Phone: 208-733-0601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD-2522
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: