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General NPI Number Information
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NPI Number | 1043443211
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Entity Type | Individual
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Provider Name | JUSTEN JOHN WILLEMON BC-HIS
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Gender | Male
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Dates
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Enumeration Date | 09/03/2009
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Last Update Date | 11/06/2018
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Provider Practice Location Address
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Address Line | 3109 RIB MOUNTAIN DR
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City | WAUSAU
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State | WI
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Zip | 54401-0650
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Country | US
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Telephone | 715-842-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 2809 SCHOFIELD AVE STE G
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City | SCHOFIELD
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State | WI
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Zip | 54476-2411
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Country | US
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Telephone | 715-298-2828
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number |
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License Number State |
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