Provider Demographics
NPI:1255576278
Name:AUDETTE, KATHLEEN ANN (ND)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:ANN
Last Name:AUDETTE
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10392 E GOLD NUGGET CT
Mailing Address - Street 2:
Mailing Address - City:GOLD CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:85118-4914
Mailing Address - Country:US
Mailing Address - Phone:480-399-4433
Mailing Address - Fax:
Practice Address - Street 1:10392 E GOLD NUGGET CT
Practice Address - Street 2:
Practice Address - City:GOLD CANYON
Practice Address - State:AZ
Practice Address - Zip Code:85118-4914
Practice Address - Country:US
Practice Address - Phone:480-399-4433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099-0000024175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ11-1248OtherNATUROPATHIC MEDICAL LICENSE