Provider Demographics
NPI:1669190203
Name:LEIN, AUDREY ANNA (CD)
Entity type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:ANNA
Last Name:LEIN
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26760 APPLE ST
Mailing Address - Street 2:
Mailing Address - City:SWEDEBORG
Mailing Address - State:MO
Mailing Address - Zip Code:65556-8503
Mailing Address - Country:US
Mailing Address - Phone:573-528-4576
Mailing Address - Fax:
Practice Address - Street 1:26760 APPLE ST
Practice Address - Street 2:
Practice Address - City:SWEDEBORG
Practice Address - State:MO
Practice Address - Zip Code:65556-8503
Practice Address - Country:US
Practice Address - Phone:573-528-4576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty