Provider Demographics
NPI:1063665354
Name:NELSON, JUDY CAROL (CPNP)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:CAROL
Last Name:NELSON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9692 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-3670
Mailing Address - Country:US
Mailing Address - Phone:301-599-7300
Mailing Address - Fax:
Practice Address - Street 1:9692 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-3670
Practice Address - Country:US
Practice Address - Phone:301-599-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRO72670364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics