Provider Demographics
NPI:1811005820
Name:HOUSER, AUDRA JUSTINE (CRNP)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:JUSTINE
Last Name:HOUSER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12234 WILLIAMS ROAD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502
Mailing Address - Country:US
Mailing Address - Phone:301-724-0132
Mailing Address - Fax:301-759-5874
Practice Address - Street 1:12234 WILLIAMS ROAD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502
Practice Address - Country:US
Practice Address - Phone:301-724-0132
Practice Address - Fax:301-759-5874
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR124238208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology