Provider Demographics
NPI:1316694961
Name:MCQUADE, AUDRA ROSE (NP)
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:ROSE
Last Name:MCQUADE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:EDWARDSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:47528-5428
Mailing Address - Country:US
Mailing Address - Phone:812-910-0520
Mailing Address - Fax:
Practice Address - Street 1:1739 N 4TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-4002
Practice Address - Country:US
Practice Address - Phone:812-242-3125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71012325A363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care