Provider Demographics
NPI:1174500672
Name:HIDEG, JUDITH ANN (CNP)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:ANN
Last Name:HIDEG
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3768 BOARDMAN CANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-8502
Mailing Address - Country:US
Mailing Address - Phone:330-533-8490
Mailing Address - Fax:330-533-8783
Practice Address - Street 1:3768 BOARDMAN CANFIELD RD
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-8502
Practice Address - Country:US
Practice Address - Phone:330-533-8490
Practice Address - Fax:330-533-8783
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP01201363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2326950Medicaid
OHP00144186OtherRR MEDICARE
OHP00144186OtherRR MEDICARE
S59743Medicare UPIN