Healthcare Provider Details

I. General information

NPI: 1700319720
Provider Name (Legal Business Name): JUDY PARKER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JUDY MANN

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E CHAPMAN AVE STE 10
ORANGE CA
92866-2237
US

IV. Provider business mailing address

1215 E CHAPMAN AVE STE 10
ORANGE CA
92866-2237
US

V. Phone/Fax

Practice location:
  • Phone: 714-516-9045
  • Fax: 714-516-9860
Mailing address:
  • Phone: 714-516-9045
  • Fax: 714-516-9860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number254743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: