Provider Demographics
NPI:1235581794
Name:DR JUDITH OCHIENG FNP-BC LLC
Entity Type:Organization
Organization Name:DR JUDITH OCHIENG FNP-BC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:OCHIENG
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:520-297-1803
Mailing Address - Street 1:PO BOX 36210
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85740-6210
Mailing Address - Country:US
Mailing Address - Phone:520-297-1803
Mailing Address - Fax:520-531-0128
Practice Address - Street 1:1925 W ORANGE GROVE RD STE 103
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1150
Practice Address - Country:US
Practice Address - Phone:520-297-1803
Practice Address - Fax:520-531-0128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-08
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5284364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty