Healthcare Provider Details

I. General information

NPI: 1386968733
Provider Name (Legal Business Name): MARY LOUISE C BROZENA AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BOULDER POINT DR SUITE 2
PLYMOUTH NH
03264-3170
US

IV. Provider business mailing address

101 BOULDER POINT DR SUITE 2
PLYMOUTH NH
03264-3170
US

V. Phone/Fax

Practice location:
  • Phone: 603-238-4234
  • Fax: 603-535-2753
Mailing address:
  • Phone: 603-238-4234
  • Fax: 603-535-2753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA310
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: