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General NPI Number Information
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NPI Number | 1134316375
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Entity Type | Individual
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Provider Name | BETH ANN HEAVNER MASTER OF AUDIOLOGY
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Gender | Female
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Dates
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Enumeration Date | 10/02/2007
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Last Update Date | 06/01/2011
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Provider Practice Location Address
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Address Line | 10000 COORS BYP NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-4040
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Country | US
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Telephone | 505-889-9100
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Fax |
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Provider Business Mailing Address
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Address Line | 8800 SE SUNNYSIDE RD 300-N
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City | CLACKAMAS
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State | OR
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Zip | 97015-5738
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Country | US
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Telephone | 503-659-5115
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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 | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | NM3838
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License Number State | NM
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