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General NPI Number Information
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NPI Number | 1124010053
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Entity Type | Individual
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Provider Name | MIEKO TANAKA AU.D.
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Gender | Female
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Dates
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Enumeration Date | 08/17/2005
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Last Update Date | 09/05/2007
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Provider Practice Location Address
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Address Line | 955 FAIRFIELD RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-5358
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Country | US
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Telephone | 910-323-9196
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Fax | 910-323-9867
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Provider Business Mailing Address
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Address Line | 955 FAIRFIELD RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-5358
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Country | US
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Telephone | 910-323-9196
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Fax | 910-323-9867
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 4646
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License Number State | NC
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