Provider Demographics
NPI:1043957814
Name:FAUDREE, ANN (MA)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:FAUDREE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1088 S GIN RD
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-7378
Mailing Address - Country:US
Mailing Address - Phone:580-509-5008
Mailing Address - Fax:
Practice Address - Street 1:1088 S GIN RD
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-7378
Practice Address - Country:US
Practice Address - Phone:580-509-5008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator