MEDICARE: ADRIENNE A PRATER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	HADE12728	AZ

General Provider Information

NPI Number	:	1366123325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIENNE A PRATER

Provider Business Mailing Address
First Line	:	1760 MCCULLOCH BLVD N STE A-102
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-6976
Country	:	US
Telephone Number	:	928-453-0303
Fax Number	:	928-453-0338

Provider Business Practice Location Address
First Line	:	1760 MCCULLOCH BLVD N STE A-102
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-6976
Country	:	US
Telephone Number	:	928-453-0303
Fax Number	:	928-453-0338

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2023
Last Update Date	:	07/31/2023

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