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General NPI Number Information
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NPI Number | 1013603489
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Entity Type | Individual
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Provider Name | AUDRA HELENA BOVENDER PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/17/2023
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Last Update Date | 04/17/2023
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Provider Practice Location Address
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Address Line | 5920 SANDY FORKS RD UNIT 200
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City | RALEIGH
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State | NC
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Zip | 27609-3814
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Country | US
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Telephone | 919-954-3174
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Fax |
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Provider Business Mailing Address
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Address Line | 109 W FORTUNE ST APT 1417
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City | TAMPA
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State | FL
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Zip | 33602-3217
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Country | US
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Telephone | 919-412-0245
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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