Individual
AUDREY BRUNO TUTTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
100818
NC
363AM0700X
Medical Physician Assistant
Primary
100818
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7508625
AETNA
—
01
—
A2435
MEDCOST
—
Enumeration date
12/13/2005
Last updated
12/10/2007
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