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General NPI Number Information
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NPI Number | 1679680417
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Entity Type | Individual
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Provider Name | GARY WYATT ANDRUS AU.D.
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Gender | Male
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1165 S DORA ST STE B2
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City | UKIAH
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State | CA
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Zip | 95482-6353
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Country | US
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Telephone | 707-468-0400
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Fax | 707-468-8240
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Provider Business Mailing Address
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Address Line | 1165 S DORA ST STE B2
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City | UKIAH
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State | CA
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Zip | 95482-6353
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Country | US
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Telephone | 707-468-0400
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Fax | 707-468-8240
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AU902
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | HA2025
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License Number State | CA
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