Provider Demographics
NPI:1407855521
Name:DAVIDSON, JUDITH E (RN, ARNP, CRNA)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:E
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:RN, ARNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 389674 MSC 18913
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98138-9674
Mailing Address - Country:US
Mailing Address - Phone:360-658-2700
Mailing Address - Fax:360-658-5091
Practice Address - Street 1:795 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3080
Practice Address - Country:US
Practice Address - Phone:360-683-2010
Practice Address - Fax:360-683-2320
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00075669163W00000X
WAAP30006215367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9636507Medicaid
WA9636507Medicaid
WAAB38019Medicare ID - Type UnspecifiedSMOKEY POINT CLINIC
WAAB38018Medicare ID - Type UnspecifiedSEQUIM CLINIC