Provider Demographics
NPI:1891482626
Name:COLE-LEATHERWOOD, AUDREY MICHELLE (RN)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:MICHELLE
Last Name:COLE-LEATHERWOOD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 WHITE IBIS DR
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-1850
Mailing Address - Country:US
Mailing Address - Phone:919-740-9751
Mailing Address - Fax:
Practice Address - Street 1:601 WILMINGTON ST
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-4956
Practice Address - Country:US
Practice Address - Phone:843-898-1151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC285949163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse