Healthcare Provider Details

I. General information

NPI: 1689075533
Provider Name (Legal Business Name): GAUTHIER SCHERLIZIN HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7829 CHICAGO PLZ
OMAHA NE
68114-3653
US

IV. Provider business mailing address

7829 CHICAGO PLZ
OMAHA NE
68114-3653
US

V. Phone/Fax

Practice location:
  • Phone: 402-933-1453
  • Fax: 402-763-8872
Mailing address:
  • Phone: 402-933-1453
  • Fax: 402-763-8872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number795
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: