Healthcare Provider Details

I. General information

NPI: 1780495473
Provider Name (Legal Business Name): VIRGINIA IRENE CHURCH HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. VIRGINIA IRENE HERINGTON

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 WASHINGTON AVE S
EDEN PRAIRIE MN
55344-3405
US

IV. Provider business mailing address

819 MAIN ST STE B
NORTH WILKESBORO NC
28659-4250
US

V. Phone/Fax

Practice location:
  • Phone: 800-328-8602
  • Fax:
Mailing address:
  • Phone: 910-620-8191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1593
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1699
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: