Healthcare Provider Details

I. General information

NPI: 1699143404
Provider Name (Legal Business Name): STEPHANIE L. JUDY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2015
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S 6TH ST
ODESSA DE
19730-2077
US

IV. Provider business mailing address

749 WOOD DUCK CT
MIDDLETOWN DE
19709-6114
US

V. Phone/Fax

Practice location:
  • Phone: 302-313-1411
  • Fax: 302-312-6150
Mailing address:
  • Phone: 302-382-7340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0000882
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0000882
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: