Provider Demographics
NPI:1699732263
Name:REDMAN, ANNETTE MARIE (DOCTOR OF AUDIOLOGY)
Entity type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:MARIE
Last Name:REDMAN
Suffix:
Gender:F
Credentials:DOCTOR OF AUDIOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 WASHINGTON AVE S
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3405
Mailing Address - Country:US
Mailing Address - Phone:612-351-1529
Mailing Address - Fax:
Practice Address - Street 1:3138 KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702
Practice Address - Country:US
Practice Address - Phone:319-234-4360
Practice Address - Fax:319-235-5360
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA387231H00000X
IA237700000X
IA632237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB1797002OtherMEDICARE
IAIB1704002OtherMEDICARE
IA2092361Medicaid
IAIB1795002OtherMEDICARE
IAIB1796002OtherMEDICARE
IAIB1798002OtherMEDICARE
IAIB1799002OtherMEDICARE