Provider Demographics
NPI:1972865996
Name:ENGLAND, BEAU T (AUD)
Entity Type:Individual
Prefix:
First Name:BEAU
Middle Name:T
Last Name:ENGLAND
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10470 W CHEYENNE AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-8733
Mailing Address - Country:US
Mailing Address - Phone:702-240-2059
Mailing Address - Fax:702-240-2065
Practice Address - Street 1:5920 S RAINBOW BLVD
Practice Address - Street 2:SUITE 9
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-4208
Practice Address - Country:US
Practice Address - Phone:702-362-3138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA-242237600000X, 231H00000X
NVA242231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV108453OtherMEDICARE