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General NPI Number Information
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NPI Number | 1962881631
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Entity Type | Organization
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Legal Business Name | LONGWOOD UNIVERSITY
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Dates
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Enumeration Date | 05/27/2015
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Last Update Date | 05/27/2015
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Provider Practice Location Address
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Address Line | 315 W 3RD ST
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City | FARMVILLE
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State | VA
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Zip | 23901-1201
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Country | US
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Telephone | 434-395-2972
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Fax | 434-395-2622
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Provider Business Mailing Address
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Address Line | PO BOX 513
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City | FARMVILLE
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State | VA
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Zip | 23901-0513
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Country | US
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Telephone | 434-395-2972
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Fax | 434-395-2622
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. ELIZABETH ANNE POWER-DEFUR
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Credential | PH.D.
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Telephone | 434-395-2972
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number | 2101001501
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License Number State | VA
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