Provider Demographics
NPI:1063665461
Name:JUDA, DEBORAH HERMAN (RN, WHNP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:HERMAN
Last Name:JUDA
Suffix:
Gender:F
Credentials:RN, WHNP
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:HERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, WHNP
Mailing Address - Street 1:2007 DREW AVENUE SOUTH
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-3620
Mailing Address - Country:US
Mailing Address - Phone:952-200-9343
Mailing Address - Fax:
Practice Address - Street 1:1409 WILLOW STREET SUITE 320
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403
Practice Address - Country:US
Practice Address - Phone:952-200-9343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN216896363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health