Healthcare Provider Details

I. General information

NPI: 1962467894
Provider Name (Legal Business Name): LUCY JUDSON P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 06/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W SOUTH BOULDER ROAD
LAFAYETTE CO
80026-1389
US

IV. Provider business mailing address

1345 PLAZA COURT NORTH #1A
LAFAYETTE CO
80026-2832
US

V. Phone/Fax

Practice location:
  • Phone: 303-665-9310
  • Fax: 720-206-0434
Mailing address:
  • Phone: 303-665-3036
  • Fax: 720-206-0434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number273
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: