Healthcare Provider Details

I. General information

NPI: 1669812830
Provider Name (Legal Business Name): NICOLE KLUTZ AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 HOSPITAL ST SUITE 3
AUGUSTA ME
04330-6651
US

IV. Provider business mailing address

89 HOSPITAL ST SUITE 3
AUGUSTA ME
04330-6651
US

V. Phone/Fax

Practice location:
  • Phone: 207-622-5922
  • Fax: 207-622-6052
Mailing address:
  • Phone: 207-622-5922
  • Fax: 207-622-6052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: