Provider Demographics
NPI:1841405966
Name:DENUNZIO, JUDITH LEE (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:LEE
Last Name:DENUNZIO
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1020 SW TAYLOR ST..
Mailing Address - Street 2:SUITE 449
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2543
Mailing Address - Country:US
Mailing Address - Phone:503-936-0191
Mailing Address - Fax:503-220-0521
Practice Address - Street 1:1020 SW TAYLOR ST
Practice Address - Street 2:SUITE 449
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2543
Practice Address - Country:US
Practice Address - Phone:503-936-0191
Practice Address - Fax:503-220-0521
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR000031960N6 PMHNP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health