MEDICARE: DIANE JUDGE NP

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
1	363L00000X	Nurse Practitioner	309000612	IL

General Provider Information

NPI Number	:	1801888193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE JUDGE NP

Provider Business Mailing Address
First Line	:	1015 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5017
Country	:	US
Telephone Number	:	773-751-1704
Fax Number	:	773-751-4175

Provider Business Practice Location Address
First Line	:	1015 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5017
Country	:	US
Telephone Number	:	773-751-1704
Fax Number	:	773-751-4175

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	03/16/2015

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Directions to “ DIANE JUDGE NP” Practice Location

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