Provider Demographics
NPI:1598254757
Name:JAWORSKI, JUDITH ANN
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:ANN
Last Name:JAWORSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:URBANSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6711 E. PLEASANT VALLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131
Mailing Address - Country:US
Mailing Address - Phone:216-536-4983
Mailing Address - Fax:
Practice Address - Street 1:6711 E PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-6351
Practice Address - Country:US
Practice Address - Phone:216-536-4983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2023-06-14
Deactivation Date:2023-02-14
Deactivation Code:
Reactivation Date:2023-03-08
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No172A00000XOther Service ProvidersDriver