Provider Demographics
NPI:1750466801
Name:ECKES, AUDREY (WHNP)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:ECKES
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 25TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2367
Mailing Address - Country:US
Mailing Address - Phone:701-241-1360
Mailing Address - Fax:
Practice Address - Street 1:1240 25TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2367
Practice Address - Country:US
Practice Address - Phone:701-241-1360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR22259363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND15458OtherBCBS
MN167M8ECOtherBCBS
MN312516500Medicaid
MN167M8ECOtherBCBS
NDP25943Medicare UPIN