1174882245 NPI number — MS. SYNTHIA ANN POTUZNIK CERTIFIED HEARING IN

Table of content: MS. SYNTHIA ANN POTUZNIK CERTIFIED HEARING IN (NPI 1174882245)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174882245 NPI number — MS. SYNTHIA ANN POTUZNIK CERTIFIED HEARING IN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POTUZNIK
Provider First Name:
SYNTHIA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CERTIFIED HEARING IN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174882245
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1327 TOWNLINE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELOIT
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-362-2669
Provider Business Mailing Address Fax Number:
608-362-2669

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1327 TOWNLINE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELOIT
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-362-2669
Provider Business Practice Location Address Fax Number:
608-362-2669
Provider Enumeration Date:
05/10/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 237700000X , with the licence number:  864-60 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 864-60 . This is a "CERTIFIED HEARING INSTRUMENT SPECIALIST" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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