Provider Demographics
NPI:1922569243
Name:CAUDILL, JUDITH RENEE (4704222736 RN)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:RENEE
Last Name:CAUDILL
Suffix:
Gender:F
Credentials:4704222736 RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:887 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-1765
Mailing Address - Country:US
Mailing Address - Phone:248-981-4562
Mailing Address - Fax:
Practice Address - Street 1:887 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-1765
Practice Address - Country:US
Practice Address - Phone:248-981-4562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704222736163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse