Healthcare Provider Details

I. General information

NPI: 1558726588
Provider Name (Legal Business Name): AARON RAY BOLENBAUGH HAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2015
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 PLUMAS ST STE 5
RENO NV
89509-3385
US

IV. Provider business mailing address

1855 PLUMAS ST STE 5
RENO NV
89509-3385
US

V. Phone/Fax

Practice location:
  • Phone: 775-825-6006
  • Fax:
Mailing address:
  • Phone: 541-773-7409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1014658
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: