MEDICARE: MR. GORDON GUINETTE

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	F02859	PA

General Provider Information

NPI Number	:	1760630578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GORDON GUINETTE

Provider Business Mailing Address
First Line	:	1366 CLEARVIEW DR
Second Line	:
City	:	DENVER
State	:	PA
Zip	:	17517
Country	:	US
Telephone Number	:	717-445-7169
Fax Number	:	717-445-7169

Provider Business Practice Location Address
First Line	:	1366 CLEARVIEW DR
Second Line	:
City	:	DENVER
State	:	PA
Zip	:	17517
Country	:	US
Telephone Number	:	717-445-7169
Fax Number	:	717-445-7169

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

Provider Enumeration Date	:	09/04/2008
Last Update Date	:	09/04/2008

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