Healthcare Provider Details

I. General information

NPI: 1457635518
Provider Name (Legal Business Name): JUDY STUART MT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2011
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 N ERIE ST ATTN BILLING 272
TOLEDO OH
43604-5317
US

IV. Provider business mailing address

635 N ERIE ST ATTN BILLING 272
TOLEDO OH
43604-5317
US

V. Phone/Fax

Practice location:
  • Phone: 419-213-4049
  • Fax: 419-213-4017
Mailing address:
  • Phone: 419-213-4049
  • Fax: 419-213-4017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number2JYX07
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: