Provider Demographics
NPI:1457743486
Name:WEDDE, AUDREY LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:LYNN
Last Name:WEDDE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:LYNN
Other - Last Name:CARRIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1045 E FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BUCHANAN
Mailing Address - State:MI
Mailing Address - Zip Code:49107-8474
Mailing Address - Country:US
Mailing Address - Phone:269-695-5540
Mailing Address - Fax:269-695-0412
Practice Address - Street 1:1045 E FRONT ST
Practice Address - Street 2:
Practice Address - City:BUCHANAN
Practice Address - State:MI
Practice Address - Zip Code:49107
Practice Address - Country:US
Practice Address - Phone:269-695-5540
Practice Address - Fax:269-695-0412
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-27
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101021544207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine