Basic Information
| Provider Information | |||||||||
| NPI: | 1649712597 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCURDY | ||||||||
| FirstName: | ANGIE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | AUDIOLOGIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4155 YELLOWSTONE HWY | ||||||||
| Address2: | PINE RIDGE MALL | ||||||||
| City: | POCATELLO | ||||||||
| State: | ID | ||||||||
| PostalCode: | 83202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082380020 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4155 YELLOWSTONE HWY | ||||||||
| Address2: | PINE RIDGE MALL | ||||||||
| City: | POCATELLO | ||||||||
| State: | ID | ||||||||
| PostalCode: | 83202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082380020 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2016 | ||||||||
| LastUpdateDate: | 11/09/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | AUDT-3072 | ID | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.