Healthcare Provider Details

I. General information

NPI: 1215191119
Provider Name (Legal Business Name): DEVIN KUERTH NBC-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 RIVERDALE RD
RIVERDALE UT
84405-1517
US

IV. Provider business mailing address

10570 SE WASHINGTON ST 202
PORTLAND OR
97216-2846
US

V. Phone/Fax

Practice location:
  • Phone: 801-334-0421
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number0322949-4601
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: