Provider Demographics
NPI:1467584243
Name:KHADRAOUI, AUDREY S (LPN)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:S
Last Name:KHADRAOUI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 FRANKLIN AVENUE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530
Mailing Address - Country:US
Mailing Address - Phone:516-782-7150
Mailing Address - Fax:516-307-5808
Practice Address - Street 1:501 FRANKLIN AVENUE
Practice Address - Street 2:SUITE 301
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530
Practice Address - Country:US
Practice Address - Phone:631-782-7150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267514164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse