Provider Demographics
NPI:1093452450
Name:ENSLIN, AUDREY ANN (CPSW)
Entity Type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:ANN
Last Name:ENSLIN
Suffix:
Gender:F
Credentials:CPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 GOLD AVE SW STE 1300
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3274
Mailing Address - Country:US
Mailing Address - Phone:505-738-5908
Mailing Address - Fax:
Practice Address - Street 1:400 GOLD AVE SW STE 1300
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3274
Practice Address - Country:US
Practice Address - Phone:505-738-5908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-17
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist