=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811679244
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MIRANDA JULIAN HIS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2023
-----------------------------------------------------
Last Update Date | 08/04/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 BLACKSTONE VALLEY PL STE 510
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02865-1102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-475-6116
-----------------------------------------------------
Fax | 401-475-6616
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 BLACKSTONE VALLEY PL STE 510
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02865-1102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-475-6116
-----------------------------------------------------
Fax | 401-475-6616
-----------------------------------------------------
=====================================================
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 | HAD00307
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------