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General NPI Number Information
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NPI Number | 1053199901
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Entity Type | Individual
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Provider Name | JUDAH O'SHAUGHNESSY RN
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Gender | Male
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Dates
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Enumeration Date | 09/20/2023
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Last Update Date | 09/20/2023
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Provider Practice Location Address
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Address Line | 1205 MYRTLE AVE
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City | EUREKA
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State | CA
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Zip | 95501-1224
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Country | US
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Telephone | 707-601-6932
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1332
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City | EUREKA
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State | CA
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Zip | 95502-1332
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Country | US
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Telephone | 707-798-7451
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 95341635
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95341635
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License Number State | CA
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