Provider Demographics
NPI:1427107226
Name:PUNNETT, AUDREY F (PHD)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:F
Last Name:PUNNETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4552 N PALM AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-3636
Mailing Address - Country:US
Mailing Address - Phone:559-225-8963
Mailing Address - Fax:
Practice Address - Street 1:4552 N PALM AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-3636
Practice Address - Country:US
Practice Address - Phone:559-225-8963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8887103TC0700X
NY0128141103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL88870Medicare ID - Type Unspecified