Provider Demographics
NPI:1548576309
Name:FURNAS, AUDREY JEAN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:JEAN
Last Name:FURNAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:
Other - Last Name:FRANTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 CAPCOM AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6531
Mailing Address - Country:US
Mailing Address - Phone:919-244-4296
Mailing Address - Fax:
Practice Address - Street 1:110 CAPCOM AVE STE 130
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6531
Practice Address - Country:US
Practice Address - Phone:919-436-4124
Practice Address - Fax:919-439-9645
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003346363A00000X
NC0010-09683363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-09683OtherLICENSE