=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912067174
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LESLIE ERNEST HINSHAW M.S., CCC-A
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2006
-----------------------------------------------------
Last Update Date | 06/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | ALBUQUERQUE AREA INDIAN HEALTH BOARD, INC 5015 PROSPECT AVE NE
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87110-4045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-764-0036
-----------------------------------------------------
Fax | 505-764-0446
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | ALBUQUERQUE AREA INDIAN HEALTH BOARD, INC 5015 PROSPECT AVE NE
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87110-4045
-----------------------------------------------------
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 | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 2451
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 396
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------