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General NPI Number Information
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NPI Number | 1881328698
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Entity Type | Individual
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Provider Name | COLLEEN DAINES
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Gender | Female
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Dates
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Enumeration Date | 07/16/2022
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Last Update Date | 07/16/2022
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Provider Practice Location Address
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Address Line | 1050 DIVISION ST
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City | MAUSTON
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State | WI
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Zip | 53948-1931
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Country | US
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Telephone | 608-847-6161
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Fax |
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Provider Business Mailing Address
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Address Line | 22727 COUNTY HIGHWAY P
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City | ONTARIO
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State | WI
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Zip | 54651-7031
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Country | US
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Telephone | 608-487-4177
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 158660
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License Number State | WI
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