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General NPI Number Information
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NPI Number | 1679573802
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Entity Type | Organization
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Legal Business Name | DANNY W GNEWIKOW PH D LLC
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Dates
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Enumeration Date | 07/29/2005
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Last Update Date | 04/10/2014
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Provider Practice Location Address
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Address Line | 743 MAIN ST
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City | DANVILLE
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State | VA
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Zip | 24541-1803
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Country | US
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Telephone | 434-799-6288
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Fax | 434-797-3685
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Provider Business Mailing Address
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Address Line | 743 MAIN ST
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City | DANVILLE
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State | VA
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Zip | 24541-1803
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Country | US
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Telephone | 434-799-6288
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Fax | 434-797-3685
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. LINDA S. GNEWIKOW
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Credential | B.A.
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Telephone | 434-799-6288
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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 | 9720000078
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License Number State | VA
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