Provider Demographics
NPI:1346236783
Name:HEBERT, AUDREY KATHERINE (RN, MSN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:KATHERINE
Last Name:HEBERT
Suffix:
Gender:F
Credentials:RN, MSN, FNP
Other - Prefix:MISS
Other - First Name:AUDREY
Other - Middle Name:KATHERINE
Other - Last Name:VARGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6015 S ABERDEEN DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53146-5204
Mailing Address - Country:US
Mailing Address - Phone:262-679-1984
Mailing Address - Fax:414-765-0226
Practice Address - Street 1:1027 N 9TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1411
Practice Address - Country:US
Practice Address - Phone:414-765-0606
Practice Address - Fax:414-765-0226
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIRN 63583-030363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4381600Medicaid