Provider Demographics
NPI:1427015734
Name:WHITAKER, JUDY ANN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:ANN
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MISS
Other - First Name:JUDY
Other - Middle Name:ANN
Other - Last Name:GRIFFEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:406 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:OIL CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16301-2820
Mailing Address - Country:US
Mailing Address - Phone:814-677-5318
Mailing Address - Fax:814-677-8794
Practice Address - Street 1:406 W 1ST ST
Practice Address - Street 2:
Practice Address - City:OIL CITY
Practice Address - State:PA
Practice Address - Zip Code:16301-2820
Practice Address - Country:US
Practice Address - Phone:814-677-5318
Practice Address - Fax:814-677-8794
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN326041L163W00000X
PASP007535363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1584292OtherHIGHMARK
PA078389Medicare ID - Type Unspecified
PA1584292OtherHIGHMARK