MEDICARE: MEGAN BRUXVOORT AU.D.

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	237600000X	Audiologist-Hearing Aid Fitter

General Provider Information

NPI Number	:	1477025435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN BRUXVOORT AU.D.

Provider Business Mailing Address
First Line	:	1201 S 13TH AVE
Second Line	:
City	:	VIRGINIA
State	:	MN
Zip	:	55792-3361
Country	:	US
Telephone Number	:	480-497-0780
Fax Number	:	480-497-0790

Provider Business Practice Location Address
First Line	:	201 W GUADALUPE RD STE 315
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85233-3334
Country	:	US
Telephone Number	:	480-497-0780
Fax Number	:	480-497-0790

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

Provider Enumeration Date	:	12/31/2018
Last Update Date	:	05/06/2020

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