Individual
AUDRA HUDDLESTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
211 7TH AVE W, BUCKEYE, AZ 85326-1020
(623) 386-4487
Mailing address
10944 W GRISWOLD RD, PEORIA, AZ 85345-2997
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP049870
AZ
Other
Enumeration date
09/20/2012
Last updated
11/17/2015
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