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General NPI Number Information
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NPI Number | 1073182937
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Entity Type | Individual
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Provider Name | ROSHELLE MARIE LEILUA HIS
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Gender | Female
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Dates
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Enumeration Date | 06/23/2021
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Last Update Date | 06/23/2021
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Provider Practice Location Address
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Address Line | 4063 W 12600 S
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City | RIVERTON
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State | UT
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Zip | 84096-7302
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Country | US
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Telephone | 801-495-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 1468 W HUNTERS VIEW CT
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City | RIVERTON
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State | UT
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Zip | 84065-6160
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Country | US
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Telephone | 801-495-4800
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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 | 7984062-4601
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License Number State | UT
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