Healthcare Provider Details

I. General information

NPI: 1386292365
Provider Name (Legal Business Name): LINDA MARLENE HALOM HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5513 ODANA RD
MADISON WI
53719-1205
US

IV. Provider business mailing address

5513 ODANA RD
MADISON WI
53719-1205
US

V. Phone/Fax

Practice location:
  • Phone: 608-256-6440
  • Fax:
Mailing address:
  • Phone: 608-256-6440
  • Fax: 608-256-7020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1568-060
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: