Provider Demographics
NPI:1437454618
Name:JUNE, JUDITH ANN (LPN)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:JUNE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 CECIL MALONE DR
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5124
Mailing Address - Country:US
Mailing Address - Phone:607-273-7780
Mailing Address - Fax:607-277-1494
Practice Address - Street 1:138 CECIL MALONE DR
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5124
Practice Address - Country:US
Practice Address - Phone:607-273-7780
Practice Address - Fax:607-277-1494
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2936231164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03534558OtherPROVIDER ID