Healthcare Provider Details

I. General information

NPI: 1073656138
Provider Name (Legal Business Name): JUDY BLANCHARD LOUDON CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUDITH LYNN LOUDON CNS

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 MAIN ST
LAFAYETTE IN
47901-1451
US

IV. Provider business mailing address

610 MAIN ST
LAFAYETTE IN
47901-1451
US

V. Phone/Fax

Practice location:
  • Phone: 765-423-2638
  • Fax:
Mailing address:
  • Phone: 765-423-2638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number70000037A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: