Provider Demographics
NPI:1023675378
Name:TRAIN, AUDREY LYNNE ROSALES (AGPCNP)
Entity type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:LYNNE ROSALES
Last Name:TRAIN
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W 63RD ST APT 4LM
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7103
Mailing Address - Country:US
Mailing Address - Phone:917-312-4346
Mailing Address - Fax:
Practice Address - Street 1:30 W 63RD ST APT 4LM
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7103
Practice Address - Country:US
Practice Address - Phone:917-312-4346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF309050363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty