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General NPI Number Information
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NPI Number | 1881581114
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Entity Type | Individual
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Provider Name | GLENN P JUDEVINE
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Gender | Male
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Dates
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Enumeration Date | 06/19/2025
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 9012 Q ST
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City | OMAHA
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State | NE
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Zip | 68127-3549
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Country | US
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Telephone | 402-690-8159
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Fax |
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Provider Business Mailing Address
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Address Line | 14823 PAUL PLZ
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City | OMAHA
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State | NE
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Zip | 68154-1160
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Country | US
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Telephone | 402-690-8159
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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 | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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