Provider Demographics
NPI:1073943734
Name:ANDERSON, JUDITH
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 HIGHCREST DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9314
Mailing Address - Country:US
Mailing Address - Phone:541-890-8069
Mailing Address - Fax:541-608-8869
Practice Address - Street 1:1309 HIGHCREST DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9314
Practice Address - Country:US
Practice Address - Phone:541-890-8069
Practice Address - Fax:541-608-8869
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-16
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR083037135RN163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health