Healthcare Provider Details

I. General information

NPI: 1548258452
Provider Name (Legal Business Name): JUDITH A ANDERSON CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS JUDITH A KUPKA

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 02/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15210 PARTHENIA ST
INORTH HILLS CA
91343
US

IV. Provider business mailing address

11550 POEMA PL
CHATSWORTH CA
91311-1119
US

V. Phone/Fax

Practice location:
  • Phone: 818-895-3100
  • Fax: 818-963-9464
Mailing address:
  • Phone: 317-937-5362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number71002231A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number22789
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: