Healthcare Provider Details

I. General information

NPI: 1790754760
Provider Name (Legal Business Name): DEBORAH MARIE JUDD FNPC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 WASHINGTON BLVD #122
OGDEN UT
84401-3122
US

IV. Provider business mailing address

2540 WASHINGTON BLVD #122
OGDEN UT
84401-3122
US

V. Phone/Fax

Practice location:
  • Phone: 801-626-3670
  • Fax: 801-626-3646
Mailing address:
  • Phone: 801-626-3670
  • Fax: 801-626-3646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5661576-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: