MEDICARE: DEBRA LAFORD

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	1456-60	WI

General Provider Information

NPI Number	:	1831636174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA LAFORD

Provider Business Mailing Address
First Line	:	1024 FOREST GRV
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54313-7025
Country	:	US
Telephone Number	:	715-524-2857
Fax Number	:	715-526-8041

Provider Business Practice Location Address
First Line	:	1053 E GREEN BAY ST
Second Line	:
City	:	SHAWANO
State	:	WI
Zip	:	54166-2203
Country	:	US
Telephone Number	:	715-524-2857
Fax Number	:	715-526-8041

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

Provider Enumeration Date	:	01/25/2017
Last Update Date	:	01/25/2017

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Directions to “ DEBRA LAFORD ” Practice Location

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