Individual
AUDREY BLAIRE WHITAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-4081
(336) 716-3065
Mailing address
100 KIMEL FOREST DR, WINSTON SALEM, NC 27103-6074
(336) 716-0238
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
50150001
NC
363L00000X
Nurse Practitioner
Primary
5015001
NC
Other
Enumeration date
09/08/2021
Last updated
09/25/2023
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