Provider Demographics
NPI:1972185197
Name:MINER, AUDREY MARIE (NBC-HWC)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:MARIE
Last Name:MINER
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9051 S 1075 W APT E102
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-9093
Mailing Address - Country:US
Mailing Address - Phone:801-682-5939
Mailing Address - Fax:
Practice Address - Street 1:9051 S 1075 W APT E102
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9093
Practice Address - Country:US
Practice Address - Phone:801-682-5939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date: