Provider Demographics
NPI:1033157797
Name:PURYEAR, JUDY (CNP)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:PURYEAR
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2067 W VISTA WAY
Mailing Address - Street 2:#250
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6031
Mailing Address - Country:US
Mailing Address - Phone:760-724-7171
Mailing Address - Fax:760-941-3986
Practice Address - Street 1:2067 W VISTA WAY
Practice Address - Street 2:#250
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6031
Practice Address - Country:US
Practice Address - Phone:760-724-7171
Practice Address - Fax:760-941-3986
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10468363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS94651Medicare UPIN