Provider Demographics
NPI:1609434232
Name:WORRELL, JUDY (DNP AGNP)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:WORRELL
Suffix:
Gender:F
Credentials:DNP AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 INTERLACHEN RD
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-8524
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5450 LYNDALE AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55419-1718
Practice Address - Country:US
Practice Address - Phone:612-256-8225
Practice Address - Fax:612-457-0216
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-29
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNRN1806928-2037590163W00000X
MN10711363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNRN1806928-2037590OtherREGISTERED NURSE