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General NPI Number Information
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NPI Number | 1851901011
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Entity Type | Individual
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Provider Name | MARINE NELLY PREVOST AUD
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Gender | Female
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Dates
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Enumeration Date | 08/03/2020
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 2910 N 3RD AVE STE 330
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City | PHOENIX
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State | AZ
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Zip | 85013-4434
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Country | US
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Telephone | 604-406-8811
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Fax | 602-406-8810
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Provider Business Mailing Address
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Address Line | 240 W THOMAS RD # 301
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City | PHOENIX
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State | AZ
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Zip | 85013-4407
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Country | US
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Telephone | 604-406-7765
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Fax | 602-294-5519
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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 | DA12485
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License Number State | AZ
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