Provider Demographics
NPI:1649586058
Name:HELGERSON, JUDY ANNE (NP)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:ANNE
Last Name:HELGERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3758 LAS VEGAS BLVD S
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-4132
Mailing Address - Country:US
Mailing Address - Phone:702-645-0332
Mailing Address - Fax:
Practice Address - Street 1:3758 LAS VEGAS BLVD S
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-4132
Practice Address - Country:US
Practice Address - Phone:702-645-0332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001712363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
IAENROLLEDMedicaid
WIENROLLEDMedicaid
MNP01021867OtherRAILROAD MEDICARE
MN500006065Medicare PIN