Provider Demographics
NPI:1518079714
Name:CROUSE, JUDY DIANE (CRNFA)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:DIANE
Last Name:CROUSE
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 HABSBURG CIR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-0389
Mailing Address - Country:US
Mailing Address - Phone:209-521-7558
Mailing Address - Fax:209-521-7558
Practice Address - Street 1:2805 HABSBURG CIR
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-0389
Practice Address - Country:US
Practice Address - Phone:209-521-7558
Practice Address - Fax:209-521-7558
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA456056163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse