Provider Demographics
NPI:1871830620
Name:MCINTYRE, JAMES JUDAH (RN)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:JUDAH
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:RN
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 330
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:CA
Mailing Address - Zip Code:95253-0330
Mailing Address - Country:US
Mailing Address - Phone:209-340-7920
Mailing Address - Fax:209-340-7960
Practice Address - Street 1:12755 N HIGHWAY 88
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-9323
Practice Address - Country:US
Practice Address - Phone:209-340-7920
Practice Address - Fax:209-340-7960
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA791016163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse