Provider Demographics
NPI:1477345981
Name:VIST, AUDREY (SRNA)
Entity type:Individual
Prefix:MISS
First Name:AUDREY
Middle Name:
Last Name:VIST
Suffix:
Gender:F
Credentials:SRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6815 LOCKWOOD BLVD APT 150
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-3915
Mailing Address - Country:US
Mailing Address - Phone:847-804-4353
Mailing Address - Fax:
Practice Address - Street 1:6815 LOCKWOOD BLVD APT 150
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-3915
Practice Address - Country:US
Practice Address - Phone:847-804-4353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program