Provider Demographics
NPI:1417923632
Name:DUKE, AUDREY M (FNP)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:M
Last Name:DUKE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-0000
Mailing Address - Country:US
Mailing Address - Phone:541-267-5151
Mailing Address - Fax:541-266-4547
Practice Address - Street 1:1900 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-0000
Practice Address - Country:US
Practice Address - Phone:541-267-5151
Practice Address - Fax:541-266-4547
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200050072NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1619915113OtherWATERFALL CLINIC -NPI
ORCB3544OtherTRAV RR GROUP NUMBER
ORP00412791OtherTRAV RR PTAN NUMBER
ORR0000WFBTVOtherGROUP PIN NUMBER
OR381902OtherWATERFALL CLINIC MEDICARE/OSCAR
OR930635514OtherGROUP TAX ID
OR291671Medicaid
OR1407812365OtherNBMC NPI NUMBER-GROUP
OR213342OtherWATERFALL CLINIC DMAP
ORCB3544OtherTRAV RR GROUP NUMBER
OR291671Medicaid
OR0577260001Medicare NSC