Provider Demographics
NPI:1316538721
Name:FACIANA, JUDY
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:FACIANA
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 1:765 TOWNSHIP ROAD 1904
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-9221
Mailing Address - Country:US
Mailing Address - Phone:419-651-6861
Mailing Address - Fax:
Practice Address - Street 1:765 TOWNSHIP ROAD 1904
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-9221
Practice Address - Country:US
Practice Address - Phone:419-651-6861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion