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NPI Code Detail

MEDICARE: NICOLE JUDKINS

MEDICARE: NICOLE JUDKINS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WS0200XSchool Registered NurseR1321186AZ

General Provider Information

NPI Number : 1588036487
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE JUDKINS
Provider Business Mailing Address
First Line : 25475 N STETSON HILLS LOOP
Second Line :
City : PHOENIX
State : AZ
Zip : 85083-1699
Country : US
Telephone Number : 623-445-5300
Fax Number :
Provider Business Practice Location Address
First Line : 25475 N STETSON HILLS LOOP
Second Line :
City : PHOENIX
State : AZ
Zip : 85083-1699
Country : US
Telephone Number : 623-445-5300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2015
Last Update Date : 10/30/2015

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Directions to “ NICOLE JUDKINS ” Practice Location

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