Healthcare Provider Details

I. General information

NPI: 1902156680
Provider Name (Legal Business Name): AUDRA ELIZABETH ALBERT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 IRONBOUND RD STE 200
WILLIAMSBURG VA
23188
US

IV. Provider business mailing address

860 OMNI BLVD STE 101
NEWPORT NEWS VA
23606-4430
US

V. Phone/Fax

Practice location:
  • Phone: 757-345-2829
  • Fax:
Mailing address:
  • Phone: 757-232-8769
  • Fax: 757-232-8875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024174085
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: