Healthcare Provider Details

I. General information

NPI: 1174631204
Provider Name (Legal Business Name): ANDREA SWEETNAM AUDIOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA SWEETNAM AUDIOLOGIST

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MEDICAL CENTER ST STE 101
EL PASO TX
79902-5008
US

IV. Provider business mailing address

1600 MEDICAL CENTER ST STE 101
EL PASO TX
79902-5008
US

V. Phone/Fax

Practice location:
  • Phone: 915-544-1350
  • Fax: 915-544-6740
Mailing address:
  • Phone: 915-544-1350
  • Fax: 915-544-6740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number51358
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: