Provider Demographics
NPI:1922487479
Name:AINSWORTH, AUDREY DAWN
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:DAWN
Last Name:AINSWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3833 MIDWAY DR
Mailing Address - Street 2:107
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5239
Mailing Address - Country:US
Mailing Address - Phone:808-224-6125
Mailing Address - Fax:
Practice Address - Street 1:3833 MIDWAY DR
Practice Address - Street 2:107
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-5239
Practice Address - Country:US
Practice Address - Phone:808-224-6125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman