Provider Demographics
NPI:1508490848
Name:JUDD, SANDRA (SRNA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:JUDD
Suffix:
Gender:F
Credentials:SRNA
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:BLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:NC
Mailing Address - Zip Code:28730-8635
Mailing Address - Country:US
Mailing Address - Phone:910-639-9816
Mailing Address - Fax:
Practice Address - Street 1:509 BILTMORE AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4601
Practice Address - Country:US
Practice Address - Phone:828-213-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-25
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC131437367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered