=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821375361
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TODD ANDREW POWELL AU.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2011
-----------------------------------------------------
Last Update Date | 08/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7001 PROSPECT PL NE
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-764-0036
-----------------------------------------------------
Fax | 505-764-0446
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7001 PROSPECT PL NE
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87110-4311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-764-0036
-----------------------------------------------------
Fax | 505-764-0446
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237600000X
-----------------------------------------------------
Taxonomy Name | Audiologist-Hearing Aid Fitter
-----------------------------------------------------
License Number | 5007
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------