Healthcare Provider Details

I. General information

NPI: 1316929185
Provider Name (Legal Business Name): JUDITH M WOJTOWICZ FNP-BC, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNE D WOJTOWICZ FNP-BC, CNM

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1518 E SANTA ROSA
EDCOUCH TX
78538
US

IV. Provider business mailing address

801 W. 1ST STREET
SAN JUAN TX
78589-2276
US

V. Phone/Fax

Practice location:
  • Phone: 956-262-1363
  • Fax:
Mailing address:
  • Phone: 956-787-8915
  • Fax: 956-787-2021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number507783
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: