Healthcare Provider Details

I. General information

NPI: 1144667825
Provider Name (Legal Business Name): DYANNA JM HAMSTRA PRAIRIE AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DYANNA J HAMSTRA AU.D.

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 03/08/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MACARTHUR BLVD AUDIOLOGY DEPARTMENT
MUNSTER IN
46321
US

IV. Provider business mailing address

2601 BEECH ST
VALPARAISO IN
46383-6008
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-1600
  • Fax: 219-703-6776
Mailing address:
  • Phone: 219-464-9580
  • Fax: 219-464-0640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number23002532A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number23002532A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: