Healthcare Provider Details

I. General information

NPI: 1316192032
Provider Name (Legal Business Name): JUDY RAYMOND RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2008
Last Update Date: 11/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 SKY OAKS DR
ANGWIN CA
94508-9627
US

IV. Provider business mailing address

1391 PARTRICK RD
NAPA CA
94558-9704
US

V. Phone/Fax

Practice location:
  • Phone: 707-965-9999
  • Fax:
Mailing address:
  • Phone: 707-255-2873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number244976
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: