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General NPI Number Information
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NPI Number | 1841716065
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Entity Type | Individual
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Provider Name | MICHELLE M LEROUX MARTINEZ AUD
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Gender | Female
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Dates
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Enumeration Date | 08/18/2017
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Last Update Date | 02/12/2018
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Provider Practice Location Address
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Address Line | 1132 N CHURCH ST STE 200
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City | GREENSBORO
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State | NC
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Zip | 27401-1040
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Country | US
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Telephone | 787-702-5495
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Fax |
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Provider Business Mailing Address
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Address Line | 1132 N CHURCH ST STE 200
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City | GREENSBORO
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State | NC
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Zip | 27401-1040
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Country | US
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Telephone | 336-702-5495
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Fax |
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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 | 12754
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License Number State | NC
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