Provider Demographics
NPI:1467475889
Name:ROHL, JUDY LEE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:LEE
Last Name:ROHL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:JUDY
Other - Middle Name:LEE
Other - Last Name:MEADOWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:35555 SPUR HWY # 188
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7625
Mailing Address - Country:US
Mailing Address - Phone:907-953-9586
Mailing Address - Fax:
Practice Address - Street 1:250 HOSPITAL PL
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-6999
Practice Address - Country:US
Practice Address - Phone:907-714-4404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164987367500000X
MNCRNA 2005367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA430002001Medicaid
MN483983800OtherMN HEALTH CARE PROVIDER
VA430002001Medicaid
VA430002001Medicare ID - Type Unspecified