Provider Demographics
NPI:1023851474
Name:MATHEWS, AUDREY JULIET (RN, BSN)
Entity type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:JULIET
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 PEBBLE DR
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-4511
Mailing Address - Country:US
Mailing Address - Phone:912-655-8272
Mailing Address - Fax:
Practice Address - Street 1:107B FAHM ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-2391
Practice Address - Country:US
Practice Address - Phone:912-655-8272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN169265163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator