Provider Demographics
NPI:1073808275
Name:VOSS, AUDREY CONSTANCE (DO)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:CONSTANCE
Last Name:VOSS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 810
Mailing Address - Street 2:BOX 185
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09589-0001
Mailing Address - Country:US
Mailing Address - Phone:757-458-2998
Mailing Address - Fax:
Practice Address - Street 1:PSC 810
Practice Address - Street 2:BOX 185
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09589-0001
Practice Address - Country:US
Practice Address - Phone:757-458-2998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-01858207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine