Provider Demographics
NPI:1891885075
Name:REDSTON- ISELIN, AUDREY (PMHCNS-BC MARN)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:REDSTON- ISELIN
Suffix:
Gender:F
Credentials:PMHCNS-BC MARN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-3508
Mailing Address - Country:US
Mailing Address - Phone:914-949-3495
Mailing Address - Fax:
Practice Address - Street 1:23 OLD MAMARONECK RD
Practice Address - Street 2:STUDIO 1
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-2061
Practice Address - Country:US
Practice Address - Phone:914-949-3495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225142-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse