Wilson, Audra Lynn

Wilson, Audra Lynn is an individual health care provider with primary practice located at 3801 5Th St Se Ste 110 , Puyallup WA 98374-2106. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Surgical. Physician Assistants & Advanced Practice Nursing Providers / Surgical is her primary health care specialty. Wilson, Audra Lynn can be contacted via phone (253) 845-9585.

Contact Information

Primary practice address
3801 5Th St Se Ste 110 Puyallup WA 98374-2106
Phone: (253) 845-9585
Fax: (253) 848-1126
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA61338060 Washington
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA61338060 Washington

Profile Details

NPI number 1336734789
LBN Legal business name Wilson, Audra Lynn
Credentials PAC
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 8th, 2021
Last updated Oct 2nd, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1336734789 NPPES
Washington MEDICAID 2215177

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