Healthcare Provider Details

I. General information

NPI: 1043533516
Provider Name (Legal Business Name): AUDREY HAUSWIRTH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 HOSPITAL RD
CHILLICOTHEE OH
45601-9031
US

IV. Provider business mailing address

256 TREGO CREEK RD
CHILLICOTHEE OH
45601-9209
US

V. Phone/Fax

Practice location:
  • Phone: 740-779-7500
  • Fax:
Mailing address:
  • Phone: 740-701-1290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0042717
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: