Provider Demographics
NPI:1932540697
Name:GUARD, AUDREY MARIE (30247)
Entity Type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:MARIE
Last Name:GUARD
Suffix:
Gender:F
Credentials:30247
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 W ATKINSON AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-6872
Mailing Address - Country:US
Mailing Address - Phone:414-544-8104
Mailing Address - Fax:
Practice Address - Street 1:2020 W ATKINSON AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-6872
Practice Address - Country:US
Practice Address - Phone:414-544-8104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30247164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse