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Individual

AUDRA BLOOD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CNP

Contact information

Practice address
16 HOSPITAL AVE, DANBURY, CT 06810-5927
(203) 778-2437
Mailing address
7232 JUSTIN WAY, MENTOR, OH 44060-4881
(440) 754-2078

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN.412126
OH
363LP2300X
Primary Care Nurse Practitioner
12487
CT
363LP2300X
Primary Care Nurse Practitioner
213101
CT
363LP2300X
Primary Care Nurse Practitioner
Primary
RN.CNP.0027907
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0423523
OH
Enumeration date
06/21/2018
Last updated
12/13/2023
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