Provider Demographics
NPI:1497595896
Name:AUDRICK, KATRINA LATRICE
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:LATRICE
Last Name:AUDRICK
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 1:20281 GLEN RUSS LN
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-2400
Mailing Address - Country:US
Mailing Address - Phone:216-318-7686
Mailing Address - Fax:
Practice Address - Street 1:20281 GLEN RUSS LN
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117-2400
Practice Address - Country:US
Practice Address - Phone:216-318-7686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker