Healthcare Provider Details

I. General information

NPI: 1952249922
Provider Name (Legal Business Name): JUDITH B MUPENDA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11000 OPTUM CIR
EDEN PRAIRIE MN
55344-2503
US

IV. Provider business mailing address

414 BRANDYBUCK DR
PIEDMONT SC
29673-7352
US

V. Phone/Fax

Practice location:
  • Phone: 888-445-8745
  • Fax:
Mailing address:
  • Phone: 864-367-9782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026004166
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: