Provider Demographics
NPI:1114141207
Name:DUARTE, JUDY M (CPNP)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:M
Last Name:DUARTE
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 1:41 TANANGER RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2656
Mailing Address - Country:US
Mailing Address - Phone:508-477-5306
Mailing Address - Fax:508-477-0297
Practice Address - Street 1:55 ROUTE 130
Practice Address - Street 2:
Practice Address - City:FORESTDALE
Practice Address - State:MA
Practice Address - Zip Code:02644-1402
Practice Address - Country:US
Practice Address - Phone:508-477-5306
Practice Address - Fax:508-477-0297
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA190872363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics