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General NPI Number Information
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NPI Number | 1285625988
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Entity Type | Individual
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Provider Name | MRS. ELIZABETH DANIELLE THAANUM
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Gender | Female
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 42 HAWTHORNE ST
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City | MEDFORD
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State | OR
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Zip | 97504-7114
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Country | US
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Telephone | 541-776-3461
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 UPPER APPLEGATE RD
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City | JACKSONVILLE
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State | OR
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Zip | 97530-9179
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Country | US
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Telephone | 541-899-2007
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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 | 22174
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License Number State | OR
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