Provider Demographics
NPI:1336530310
Name:TWIT, AUDREY JEAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:JEAN
Last Name:TWIT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 NORTH THIRD STREET
Mailing Address - Street 2:ESSENTIA HEALTH ST JOSEPH'S MEDICAL CENTER
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401
Mailing Address - Country:US
Mailing Address - Phone:218-828-7364
Mailing Address - Fax:218-828-7369
Practice Address - Street 1:523 NORTH THIRD STREET
Practice Address - Street 2:ESSENTIA HEALTH ST JOSEPH'S MEDICAL CENTER
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401
Practice Address - Country:US
Practice Address - Phone:218-828-7364
Practice Address - Fax:218-828-7369
Is Sole Proprietor?:No
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116067-71835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist