Basic Information
| Provider Information | |||||||||
| NPI: | 1699732263 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REDMAN | ||||||||
| FirstName: | ANNETTE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DOCTOR OF AUDIOLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6700 WASHINGTON AVE S | ||||||||
| Address2: | |||||||||
| City: | EDEN PRAIRIE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553443405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123511529 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3138 KIMBALL AVE | ||||||||
| Address2: | |||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 50702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192344360 | ||||||||
| FaxNumber: | 3192355360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 11/16/2018 | ||||||||
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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 | 387 | IA | N | Speech, Language and Hearing Service Providers | Audiologist | 237700000X | IA | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 237600000X | 632 | IA | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
ID Information
| ID | Type | State | Issuer | Description | IB1797002 | 01 | IA | MEDICARE | OTHER | IB1704002 | 01 | IA | MEDICARE | OTHER | 2092361 | 05 | IA | MEDICAID | IB1795002 | 01 | IA | MEDICARE | OTHER | IB1796002 | 01 | IA | MEDICARE | OTHER | IB1798002 | 01 | IA | MEDICARE | OTHER | IB1799002 | 01 | IA | MEDICARE | OTHER |