=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588323067
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSHUA ALAN ROSENBERGER HIS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2021
-----------------------------------------------------
Last Update Date | 12/13/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 NORTH ST STE 5
-----------------------------------------------------
City | PRESQUE ISLE
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04769-2269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-573-0915
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 937
-----------------------------------------------------
City | PRESQUE ISLE
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04769-0937
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-573-0915
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | DL442
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------