Provider Demographics
NPI:1063938413
Name:WASHO, AUDRA DANIELLE (APN)
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:DANIELLE
Last Name:WASHO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:AUDRA
Other - Middle Name:DANIELLE
Other - Last Name:CHOATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:403 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-3187
Mailing Address - Country:US
Mailing Address - Phone:815-284-5710
Mailing Address - Fax:815-285-5893
Practice Address - Street 1:403 E 1ST ST
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021
Practice Address - Country:US
Practice Address - Phone:815-284-5710
Practice Address - Fax:815-285-5893
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016371363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily