Provider Demographics
NPI:1619101144
Name:MAUSIA, AUDREY LEAURO (RN)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:LEAURO
Last Name:MAUSIA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:LEAURO
Other - Last Name:ALAFUA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5965 S 900 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-1720
Mailing Address - Country:US
Mailing Address - Phone:801-963-4216
Mailing Address - Fax:801-963-4299
Practice Address - Street 1:5965 S 900 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-1720
Practice Address - Country:US
Practice Address - Phone:801-963-4216
Practice Address - Fax:801-963-4299
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT58345363102163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health