MEDICARE: JUDITH ANN PINGSTON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	4704150355	MI

General Provider Information

NPI Number	:	1215127923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH ANN PINGSTON RN

Provider Business Mailing Address
First Line	:	916 CLEVELAND AVE
Second Line	:	APT #8
City	:	MARQUETTE
State	:	MI
Zip	:	49855-3256
Country	:	US
Telephone Number	:	906-225-0156
Fax Number	:

Provider Business Practice Location Address
First Line	:	916 CLEVELAND AVE
Second Line	:	APT #8
City	:	MARQUETTE
State	:	MI
Zip	:	49855-3256
Country	:	US
Telephone Number	:	906-225-0156
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2007
Last Update Date	:	07/29/2007

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