Healthcare Provider Details

I. General information

NPI: 1871390542
Provider Name (Legal Business Name): AUDRA BENEE TRAVERS RH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2025
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 COURTLEIGH DR
RANDALLSTOWN MD
21133-4806
US

IV. Provider business mailing address

3605 COURTLEIGH DR
RANDALLSTOWN MD
21133-4806
US

V. Phone/Fax

Practice location:
  • Phone: 443-788-4885
  • Fax:
Mailing address:
  • Phone: 443-788-4885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: