Provider Demographics
NPI:1225367543
Name:HANSLEY, AUDRA YVETTE
Entity Type:Individual
Prefix:MRS
First Name:AUDRA
Middle Name:YVETTE
Last Name:HANSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AUDRA
Other - Middle Name:
Other - Last Name:HATCHER-MAXIMIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:192 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-2006
Mailing Address - Country:US
Mailing Address - Phone:347-825-3778
Mailing Address - Fax:
Practice Address - Street 1:192 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-2006
Practice Address - Country:US
Practice Address - Phone:347-825-3778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242137164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse