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Individual

MRS. ELIZABETH DANIELLE THAANUM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
42 HAWTHORNE ST, MEDFORD, OR 97504-7114
(541) 776-3461
Mailing address
1401 UPPER APPLEGATE RD, JACKSONVILLE, OR 97530-9179
(541) 899-2007

Taxonomy

Speciality
Code
Description
License number
State
237600000X
Audiologist-Hearing Aid Fitter
Primary
22174
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
002387312-002
UNITEDHEALTHCARE PROV. #
OR
05
226610
OR
01
408242302
PREF. CHOICE 65 PROV. #
OR
01
858535002
BCBS OF OREGON PROV. #
OR
01
J133302
PACIFICSOURCE PIN NUMBER
OR
Enumeration date
11/02/2005
Last updated
07/09/2007
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