Healthcare Provider Details

I. General information

NPI: 1386526572
Provider Name (Legal Business Name): JUD SIMONDS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 E OLIVE WAY APT 117
SEATTLE WA
98102-5646
US

IV. Provider business mailing address

1711 E OLIVE WAY APT 117
SEATTLE WA
98102-5646
US

V. Phone/Fax

Practice location:
  • Phone: 619-890-3180
  • Fax:
Mailing address:
  • Phone: 619-890-3180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN60523979
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: