Healthcare Provider Details

I. General information

NPI: 1821353384
Provider Name (Legal Business Name): EMMA RICE BENTHAM AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 01/13/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1839 QUIET CV
FAYETTEVILLE NC
28304-3857
US

IV. Provider business mailing address

1839 QUIET CV
FAYETTEVILLE NC
28304-3857
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-1463
  • Fax: 910-323-1575
Mailing address:
  • Phone: 910-323-1463
  • Fax: 910-323-1575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number10054
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number10054
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: