Provider Demographics
NPI:1558508283
Name:DAOUST, JUDITH E (MS, PAC)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:E
Last Name:DAOUST
Suffix:
Gender:F
Credentials:MS, PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3496 E LAKE LANSING RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-2288
Mailing Address - Country:US
Mailing Address - Phone:517-780-6157
Mailing Address - Fax:517-780-6144
Practice Address - Street 1:3496 E LAKE LANSING RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-2288
Practice Address - Country:US
Practice Address - Phone:517-780-6157
Practice Address - Fax:517-780-6144
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002236363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical