Provider Demographics
NPI:1235600891
Name:STUMBAUGH, AUDRA
Entity Type:Individual
Prefix:MRS
First Name:AUDRA
Middle Name:
Last Name:STUMBAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ARCTIC AVE
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-4171
Mailing Address - Country:US
Mailing Address - Phone:307-670-2181
Mailing Address - Fax:
Practice Address - Street 1:10 ARCTIC AVE
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-4171
Practice Address - Country:US
Practice Address - Phone:307-670-2181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist