Healthcare Provider Details

I. General information

NPI: 1124347414
Provider Name (Legal Business Name): JUDY G BOERSMA AUDIOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 05/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 SCHAN DR
CHURCHVILLE PA
18966-1619
US

IV. Provider business mailing address

173 SCHAN DR
CHURCHVILLE PA
18966-1619
US

V. Phone/Fax

Practice location:
  • Phone: 215-485-3205
  • Fax:
Mailing address:
  • Phone: 215-485-3205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAT000690L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: