Healthcare Provider Details

I. General information

NPI: 1801243290
Provider Name (Legal Business Name): SHIRLEY LAM HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 SAINT MICHAELS DR STE 901
SANTA FE NM
87505-7619
US

IV. Provider business mailing address

215 SHUMAN BLVD STE 401
NAPERVILLE IL
60563-8458
US

V. Phone/Fax

Practice location:
  • Phone: 505-820-6500
  • Fax: 505-820-0339
Mailing address:
  • Phone: 331-229-8208
  • Fax: 978-313-6824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number871
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number80617
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: