Healthcare Provider Details

I. General information

NPI: 1285625988
Provider Name (Legal Business Name): MRS. ELIZABETH DANIELLE THAANUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH DANIELLE TANGEL M.S., CCC-A

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 HAWTHORNE ST
MEDFORD OR
97504-7114
US

IV. Provider business mailing address

1401 UPPER APPLEGATE RD
JACKSONVILLE OR
97530-9179
US

V. Phone/Fax

Practice location:
  • Phone: 541-776-3461
  • Fax:
Mailing address:
  • Phone: 541-899-2007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number22174
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: