MEDICARE: AUDAIN PIERRE JR. CRNA, APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	26NR11270100	NJ

General Provider Information

NPI Number	:	1437154929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDAIN PIERRE JR. CRNA, APN

Provider Business Mailing Address
First Line	:	3998 FAIR RIDGE DRIVE
Second Line	:	SUITE 300
City	:	FAIRFAX
State	:	VA
Zip	:	22033-2150
Country	:	US
Telephone Number	:	703-295-9360
Fax Number	:	703-766-9725

Provider Business Practice Location Address
First Line	:	901 W MAIN ST
Second Line	:
City	:	FREEHOLD
State	:	NJ
Zip	:	07728-2537
Country	:	US
Telephone Number	:	732-294-2876
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	03/13/2015

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