Provider Demographics
NPI:1790767606
Name:JUDKINS, ANN BUNNELL (CNM, NP, MA)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:BUNNELL
Last Name:JUDKINS
Suffix:
Gender:F
Credentials:CNM, NP, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 DUNCAN ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:NY
Mailing Address - Zip Code:14569-1017
Mailing Address - Country:US
Mailing Address - Phone:585-786-3230
Mailing Address - Fax:585-786-3367
Practice Address - Street 1:34 DUNCAN ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-1017
Practice Address - Country:US
Practice Address - Phone:585-786-3230
Practice Address - Fax:585-786-3367
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF360168363LW0102X
NY186706163WP1700X
NYF000099367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WP1700XNursing Service ProvidersRegistered NursePerinatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01041309Medicaid
NY55390BMedicare ID - Type Unspecified