Provider Demographics
NPI:1265052906
Name:NISBET, AUDREY IRENE (MD)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:IRENE
Last Name:NISBET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PASTEUR DR RM HC 435
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-2200
Mailing Address - Country:US
Mailing Address - Phone:650-736-1227
Mailing Address - Fax:650-724-0866
Practice Address - Street 1:300 PASTEUR DR RM HC 435
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-736-1227
Practice Address - Fax:650-724-0866
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA2033712085R0202X
AZR779562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology