Individual
AUDREY M DUKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1900 WOODLAND DR, COOS BAY, OR 97420-0000
(541) 267-5151
(541) 266-4547
Mailing address
1900 WOODLAND DR, COOS BAY, OR 97420-0000
(541) 267-5151
(541) 266-4547
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
200050072NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1407812365
NBMC NPI NUMBER-GROUP
OR
01
—
1619915113
WATERFALL CLINIC -NPI
OR
01
—
213342
WATERFALL CLINIC DMAP
OR
05
—
291671
—
OR
01
—
381902
WATERFALL CLINIC MEDICARE/OSCAR
OR
01
—
930635514
GROUP TAX ID
OR
01
—
CB3544
TRAV RR GROUP NUMBER
OR
01
—
P00412791
TRAV RR PTAN NUMBER
OR
01
—
R0000WFBTV
GROUP PIN NUMBER
OR
Enumeration date
02/27/2006
Last updated
05/20/2013
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