Provider Demographics
NPI:1508971078
Name:DESCHAMPS, JUDITH A (RN, MSN, NP-C)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:DESCHAMPS
Suffix:
Gender:F
Credentials:RN, MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:29325 HEALTH CAMPUS DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-8201
Mailing Address - Country:US
Mailing Address - Phone:440-414-9412
Mailing Address - Fax:440-414-9059
Practice Address - Street 1:125 E BROAD ST
Practice Address - Street 2:SUITE 305
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-6400
Practice Address - Country:US
Practice Address - Phone:440-414-9100
Practice Address - Fax:440-322-4104
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2011-03-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OHRN167699363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPENDINGMedicaid
PENDINGMedicare ID - Type Unspecified
OHPENDINGMedicaid