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General NPI Number Information
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NPI Number | 1679053110
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Entity Type | Organization
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Legal Business Name | HEARING CARE BY GINA LLC
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Dates
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Enumeration Date | 08/15/2018
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Last Update Date | 08/30/2018
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Provider Practice Location Address
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Address Line | 408 N 1ST ST STE 2
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City | MONTEVIDEO
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State | MN
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Zip | 56265
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Country | US
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Telephone | 320-321-1551
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Fax |
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Provider Business Mailing Address
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Address Line | 408 N 1ST ST STE 2
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City | MONTEVIDEO
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State | MN
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Zip | 56265-4551
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Country | US
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Telephone | 320-321-1551
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Fax |
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Authorized Official
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Title or Position | AUDIOLOGIST
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Name | MRS. GINA KONTZ
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Credential | M.A.
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Telephone | 320-321-1551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 6279
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License Number State | MN
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