Healthcare Provider Details

I. General information

NPI: 1366647166
Provider Name (Legal Business Name): DEBRA J JUDD R.N., ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W 5TH AVE STE 104
SPOKANE WA
99204-2823
US

IV. Provider business mailing address

PO BOX 30507
SPOKANE WA
99223-3008
US

V. Phone/Fax

Practice location:
  • Phone: 509-747-7066
  • Fax: 509-838-3148
Mailing address:
  • Phone: 509-747-7066
  • Fax: 509-838-3148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberRN00064849
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60393686
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: