Provider Demographics
NPI:1053414920
Name:NIKANDER, MARYANN MCCULLOUGH (AUD)
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:MCCULLOUGH
Last Name:NIKANDER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:MARYANN
Other - Middle Name:D
Other - Last Name:MCCULLOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:65 W STREET RD
Mailing Address - Street 2:SUITE B-104
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-3226
Mailing Address - Country:US
Mailing Address - Phone:215-672-4327
Mailing Address - Fax:215-646-0565
Practice Address - Street 1:65 W STREET RD
Practice Address - Street 2:SUITE B-104
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-3226
Practice Address - Country:US
Practice Address - Phone:215-672-4327
Practice Address - Fax:215-646-0565
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT-000394-L237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
1770752511OtherGROUP NPI
130578OtherMEDICARE PTAN
1770752511OtherGROUP NPI