Provider Demographics
NPI:1821303728
Name:ALTIZER, JUDY MARIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:MARIE
Last Name:ALTIZER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 90004
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24062-9004
Mailing Address - Country:US
Mailing Address - Phone:540-953-5122
Mailing Address - Fax:540-953-5496
Practice Address - Street 1:3700 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7017
Practice Address - Country:US
Practice Address - Phone:540-953-5122
Practice Address - Fax:540-953-5496
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017139772363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner