Healthcare Provider Details

I. General information

NPI: 1972620094
Provider Name (Legal Business Name): JUDITH HAUCK DNP, RN, PMHCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 ENCK CIR
ENOLA PA
17025-1050
US

IV. Provider business mailing address

3 ENCK CIR
ENOLA PA
17025-1050
US

V. Phone/Fax

Practice location:
  • Phone: 717-576-9243
  • Fax: 866-683-4434
Mailing address:
  • Phone: 717-576-9243
  • Fax: 866-683-4434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN195926L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: