Healthcare Provider Details

I. General information

NPI: 1700093713
Provider Name (Legal Business Name): NATALIE AMANDA AUDAIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 CHILDRENS WAY MC 5008
SAN DIEGO CA
92123-4223
US

IV. Provider business mailing address

875 G STREET SUITE 213
SAN DIEGO CA
92101
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-5888
  • Fax:
Mailing address:
  • Phone: 917-763-4207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number17124
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: