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General NPI Number Information
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NPI Number | 1285674200
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Entity Type | Organization
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Legal Business Name | NORTHLAND US LLC
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1404 W MAIN ST
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City | CARBONDALE
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State | IL
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Zip | 62901-2230
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Country | US
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Telephone | 618-351-7179
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Fax | 618-519-9306
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Provider Business Mailing Address
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Address Line | 1404 W MAIN ST
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City | CARBONDALE
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State | IL
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Zip | 62901-2230
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Country | US
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Telephone | 618-351-7179
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Fax | 618-519-9306
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MARK HOLTZ
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Credential |
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Telephone | 952-486-8734
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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 | 2788
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License Number State | IL
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