Healthcare Provider Details

I. General information

NPI: 1871842435
Provider Name (Legal Business Name): LUKE ANDERSON HINZMANN AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 06/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W MAPLE ST
FARMINGTON NM
87401
US

IV. Provider business mailing address

801 W MAPLE ST
FARMINGTON NM
87401-5630
US

V. Phone/Fax

Practice location:
  • Phone: 505-609-6079
  • Fax: 505-609-2259
Mailing address:
  • Phone: 505-609-6079
  • Fax: 505-609-2259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number658
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: