Provider Demographics
NPI:1154864015
Name:NUWAVE HEARING CENTER
Entity Type:Organization
Organization Name:NUWAVE HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-561-3902
Mailing Address - Street 1:22601 ALLEN RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2273
Mailing Address - Country:US
Mailing Address - Phone:734-561-3902
Mailing Address - Fax:
Practice Address - Street 1:22601 ALLEN RD
Practice Address - Street 2:SUITE 300
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-2273
Practice Address - Country:US
Practice Address - Phone:734-561-3902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501004516237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty