Provider Demographics
NPI:1407521404
Name:JUDSON, GAIL MARIE (RN)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:MARIE
Last Name:JUDSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:MARIE
Other - Last Name:JUDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3240 MOUNT READ BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14616-4342
Mailing Address - Country:US
Mailing Address - Phone:310-245-0910
Mailing Address - Fax:
Practice Address - Street 1:3240 MOUNT READ BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-4342
Practice Address - Country:US
Practice Address - Phone:310-245-0910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9461712163W00000X
NY729432163W00000X
NV73573163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse