Healthcare Provider Details

I. General information

NPI: 1619050598
Provider Name (Legal Business Name): LOIS DEBOZY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2534 N MAIN ST
HUTCHINSON KS
67502-3641
US

IV. Provider business mailing address

2534 N MAIN ST
HUTCHINSON KS
67502-3641
US

V. Phone/Fax

Practice location:
  • Phone: 620-665-8835
  • Fax: 620-665-6252
Mailing address:
  • Phone: 620-665-8835
  • Fax: 620-665-6252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1330
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: