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General NPI Number Information
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NPI Number | 1417026626
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Entity Type | Organization
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Legal Business Name | BERTHA WHITNEY
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 07/15/2008
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Provider Practice Location Address
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Address Line | 1927 IDAHO STREET
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City | LEWISTON
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State | ID
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Zip | 83501-2563
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Country | US
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Telephone | 208-746-8547
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Fax | 208-746-5579
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Provider Business Mailing Address
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Address Line | 9751 N GOVT WAY STE 6
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City | HAYDEN
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State | ID
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Zip | 83835-9645
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Country | US
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Telephone | 208-746-8547
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Fax | 208-746-5579
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Authorized Official
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Title or Position | OWNER CONSULTANT
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Name | BERTHA ELDER WHITNEY
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Credential | HEARING CONSULTANT
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Telephone | 208-746-8547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number | H197
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License Number State | ID
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