Provider Demographics
NPI:1003350596
Name:ABEL, AUDRA
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:
Last Name:ABEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AUDRA
Other - Middle Name:
Other - Last Name:HOPF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:6090 STATE ROAD 62 APT 33
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47122-9291
Mailing Address - Country:US
Mailing Address - Phone:502-548-1232
Mailing Address - Fax:
Practice Address - Street 1:6090 STATE ROAD 62 APT 33
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:IN
Practice Address - Zip Code:47122-9291
Practice Address - Country:US
Practice Address - Phone:502-548-1232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006756A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily