Healthcare Provider Details

I. General information

NPI: 1437221645
Provider Name (Legal Business Name): LORRAINE AGNES KENNEDY-VOSU M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 RYLAND ST
RENO NV
89502-1602
US

IV. Provider business mailing address

821 RYLAND ST
RENO NV
89502-1602
US

V. Phone/Fax

Practice location:
  • Phone: 775-322-4327
  • Fax: 775-327-4227
Mailing address:
  • Phone: 775-322-4327
  • Fax: 775-327-4227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA153
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: