Provider Demographics
NPI:1235941873
Name:RICH, AUDREY
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:RICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 BEAR GRASS RD W
Mailing Address - Street 2:
Mailing Address - City:LONGS
Mailing Address - State:SC
Mailing Address - Zip Code:29568-8040
Mailing Address - Country:US
Mailing Address - Phone:843-360-6808
Mailing Address - Fax:
Practice Address - Street 1:1311 BEAR GRASS RD W
Practice Address - Street 2:
Practice Address - City:LONGS
Practice Address - State:SC
Practice Address - Zip Code:29568-8040
Practice Address - Country:US
Practice Address - Phone:843-360-6808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC273832163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse