Provider Demographics
NPI:1417933763
Name:ELLER, JUDITH M (RN)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:M
Last Name:ELLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:11572 S RUSSIAN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-9324
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:US COAST GUARD ISC KODIAK
Practice Address - Street 2:BLDG N46
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99619-5002
Practice Address - Country:US
Practice Address - Phone:907-487-5757
Practice Address - Fax:907-487-5151
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK14210163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care