Provider Demographics
NPI:1902830151
Name:JEGLIJEWSKI, JUDITH MARIE (APRN, BC, MS, CDE)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:MARIE
Last Name:JEGLIJEWSKI
Suffix:
Gender:F
Credentials:APRN, BC, MS, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 VILLAGE MEAD DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-6129
Mailing Address - Country:US
Mailing Address - Phone:314-469-6224
Mailing Address - Fax:314-469-0744
Practice Address - Street 1:222 S WOODS MILL RD
Practice Address - Street 2:SUITE 410N
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3625
Practice Address - Country:US
Practice Address - Phone:314-469-6224
Practice Address - Fax:314-469-0744
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN201534163W00000X
MORN046407163WD0400X
MO124987-21363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO166795OtherBC/BS
MO813144580Medicare ID - Type Unspecified
P66410Medicare UPIN