Provider Demographics
NPI:1114529898
Name:WISE COLDIRON, JUDY LYNN
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:LYNN
Last Name:WISE COLDIRON
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 1:1336 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WEST PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45663-6013
Mailing Address - Country:US
Mailing Address - Phone:174-072-7219
Mailing Address - Fax:
Practice Address - Street 1:1349 2ND ST
Practice Address - Street 2:
Practice Address - City:WEST PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45663-6004
Practice Address - Country:US
Practice Address - Phone:740-858-2949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty