Provider Demographics
NPI:1619326105
Name:JUDD, HANNAH LOIS (LPN)
Entity Type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:LOIS
Last Name:JUDD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:LOIS
Other - Last Name:REA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:7 PIN OAK DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3412
Mailing Address - Country:US
Mailing Address - Phone:501-428-6178
Mailing Address - Fax:
Practice Address - Street 1:1175 MORNINGSIDE DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-3647
Practice Address - Country:US
Practice Address - Phone:501-327-7642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL053974164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse