Healthcare Provider Details

I. General information

NPI: 1417026626
Provider Name (Legal Business Name): BERTHA WHITNEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1927 IDAHO STREET
LEWISTON ID
83501-2563
US

IV. Provider business mailing address

9751 N GOVT WAY STE 6
HAYDEN ID
83835-9645
US

V. Phone/Fax

Practice location:
  • Phone: 208-746-8547
  • Fax: 208-746-5579
Mailing address:
  • Phone: 208-746-8547
  • Fax: 208-746-5579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberH197
License Number StateID

VIII. Authorized Official

Name: BERTHA ELDER WHITNEY
Title or Position: OWNER CONSULTANT
Credential: HEARING CONSULTANT
Phone: 208-746-8547