Provider Demographics
NPI:1881153849
Name:PROWELL, AUDRA CHAFONE
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:CHAFONE
Last Name:PROWELL
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 1:3332 S 60TH CT
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-3712
Mailing Address - Country:US
Mailing Address - Phone:708-749-7470
Mailing Address - Fax:
Practice Address - Street 1:3332 S 60TH CT
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-3712
Practice Address - Country:US
Practice Address - Phone:708-749-7470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)