Provider Demographics
NPI:1235133570
Name:WAROLIN, AUDREY KAY (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:KAY
Last Name:WAROLIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:AUDREY
Other - Middle Name:KAY
Other - Last Name:DEJONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1400 E. KINCAID STREET
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4127
Mailing Address - Country:US
Mailing Address - Phone:360-428-2500
Mailing Address - Fax:360-428-6485
Practice Address - Street 1:208 S. 14TH STREET
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4117
Practice Address - Country:US
Practice Address - Phone:360-814-2600
Practice Address - Fax:360-814-8390
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006911363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner