Healthcare Provider Details

I. General information

NPI: 1245213511
Provider Name (Legal Business Name): JUDITH A BJORK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 EAST H STREET OSCAR G. JOHNSON VA MEDICAL CENTER
IRON MOUNTAIN MI
49801-4792
US

IV. Provider business mailing address

325 E H ST
IRON MOUNTAIN MI
49801-4760
US

V. Phone/Fax

Practice location:
  • Phone: 906-774-3300
  • Fax:
Mailing address:
  • Phone: 906-774-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704122796
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1028 033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: