Individual
CHANDLER BEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BC-HIS
Contact information
Practice address
110 N 37TH ST BLDG 3, NORFOLK, NE 68701-3283
(402) 371-8295
Mailing address
PO BOX 5224, GRAND ISLAND, NE 68802-5224
(402) 366-3489
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
730
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1002532400
—
NE
Enumeration date
05/03/2011
Last updated
12/11/2015
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