Provider Demographics
NPI:1083947451
Name:FELKER, AUDRA LYNN (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:AUDRA
Middle Name:LYNN
Last Name:FELKER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 N PORT WASHINGTON RD
Mailing Address - Street 2:ATTN: CSMCP CLINIC CREDENTIALING
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1082
Mailing Address - Country:US
Mailing Address - Phone:414-271-1633
Mailing Address - Fax:414-271-5071
Practice Address - Street 1:2350 N LAKE DR
Practice Address - Street 2:SUITE 400
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4528
Practice Address - Country:US
Practice Address - Phone:414-271-1633
Practice Address - Fax:414-271-5071
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3854363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner