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General NPI Number Information
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NPI Number | 1578075594
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Entity Type | Individual
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Provider Name | LISA WHITE LEDBURY HIS.
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Gender | Female
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Dates
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Enumeration Date | 10/31/2017
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Last Update Date | 01/18/2024
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Provider Practice Location Address
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Address Line | 200 CBL DR. STE. 104
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City | ST. AUGUSTINE
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State | FL
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Zip | 32086-5174
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Country | US
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Telephone | 904-429-7513
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Fax | 904-429-7504
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Provider Business Mailing Address
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Address Line | 750 N COMMONS DR STE 200
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City | AURORA
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State | IL
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Zip | 60504-7940
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Country | US
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Telephone | 630-303-5380
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Fax | 630-303-5385
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 2101002796
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | AS5311
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License Number State | FL
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