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General NPI Number Information
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NPI Number | 1902366800
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Entity Type | Individual
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Provider Name | THOMAS NIELSEN GWYNN HIS
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Gender | Male
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Dates
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Enumeration Date | 03/25/2019
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Last Update Date | 03/25/2019
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Provider Practice Location Address
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Address Line | 843 W STUART DR
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City | HILLSVILLE
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State | VA
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Zip | 24343-1577
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Country | US
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Telephone | 276-728-9323
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Fax |
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Provider Business Mailing Address
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Address Line | 1711 SW 27TH PL
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City | OCALA
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State | FL
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Zip | 34471-7802
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Country | US
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Telephone | 352-789-2742
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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 | 2101002440
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License Number State | VA
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