Provider Demographics
NPI:1326603705
Name:LATHBURY, AUDRA A
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:A
Last Name:LATHBURY
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 1:32242 BLACKWATER RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19945-2937
Mailing Address - Country:US
Mailing Address - Phone:302-539-0596
Mailing Address - Fax:
Practice Address - Street 1:32242 BLACKWATER RD
Practice Address - Street 2:
Practice Address - City:FRANKFORD
Practice Address - State:DE
Practice Address - Zip Code:19945-2937
Practice Address - Country:US
Practice Address - Phone:302-539-0596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0043491163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse