Healthcare Provider Details

I. General information

NPI: 1609047919
Provider Name (Legal Business Name): APRIL L FAGERSON M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S EAGLE RD ST 1225
MERIDIAN ID
83642-6308
US

IV. Provider business mailing address

520 S EAGLE RD ST 1225
MERIDIAN ID
83642-6308
US

V. Phone/Fax

Practice location:
  • Phone: 208-489-5999
  • Fax:
Mailing address:
  • Phone: 208-489-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD1381
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: