Provider Demographics
NPI:1568421006
Name:MISIASZEK, JUDY A (APRN)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:A
Last Name:MISIASZEK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 ROUTE 125
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NH
Mailing Address - Zip Code:03848-3535
Mailing Address - Country:US
Mailing Address - Phone:603-642-6700
Mailing Address - Fax:603-642-6701
Practice Address - Street 1:80 ROUTE 125
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NH
Practice Address - Zip Code:03848-3535
Practice Address - Country:US
Practice Address - Phone:603-642-6700
Practice Address - Fax:603-642-6701
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH027211-23-05363LA2200X
MA92779363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0327611Medicaid
NH152212OtherCIGNA NEW HAMPSHIRE
NH7469782OtherAETNA PPO
NH1129363OtherAETNA HMO
NH30342329Medicaid
MANP4193OtherBCBS MASSACHUSETTS
MA7038239OtherCIGNA NATIONAL
NH23YP05046NH01OtherBCBS NEW HAMPSHIRE
P91198Medicare UPIN
NP4193Medicare ID - Type Unspecified