Provider Demographics
NPI:1225658099
Name:SUDO, JUDY L (DNP, MSA, ACAGNP-BC)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:L
Last Name:SUDO
Suffix:
Gender:F
Credentials:DNP, MSA, ACAGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 MCCLINTOCK DR STE 360
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0875
Mailing Address - Country:US
Mailing Address - Phone:630-310-5195
Mailing Address - Fax:
Practice Address - Street 1:19840 HARPER AVE
Practice Address - Street 2:
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-1804
Practice Address - Country:US
Practice Address - Phone:630-832-1775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704130424363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care