Provider Demographics
NPI:1558785550
Name:MUDD, JUDY (RN)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:
Last Name:MUDD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3436 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-5967
Mailing Address - Country:US
Mailing Address - Phone:440-998-4411
Mailing Address - Fax:
Practice Address - Street 1:2428 BLAKE RD
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-4548
Practice Address - Country:US
Practice Address - Phone:440-997-5301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN178231163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool