Provider Demographics
NPI:1295420370
Name:CHU, AUDREY LYNETTE
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:LYNETTE
Last Name:CHU
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 1:1991 SHENANDOAH LN
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-7971
Mailing Address - Country:US
Mailing Address - Phone:630-797-1172
Mailing Address - Fax:
Practice Address - Street 1:150 55TH STREET
Practice Address - Street 2:STATION 20
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-2574
Practice Address - Country:US
Practice Address - Phone:718-630-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program