Provider Demographics
NPI:1265052906
Name:NISBET, AUDREY IRENE (MD)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:IRENE
Last Name:NISBET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 N CAMPBELL AVE, SUITE 1343
Mailing Address - Street 2:PO BOX 245067
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85724-5040
Mailing Address - Country:US
Mailing Address - Phone:520-626-7402
Mailing Address - Fax:520-626-1518
Practice Address - Street 1:1501 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-5040
Practice Address - Country:US
Practice Address - Phone:520-626-7402
Practice Address - Fax:520-626-1518
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2023-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR77956207R00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine