Provider Demographics
NPI:1932696861
Name:JUDGE, LAWANDA DENISE (DNP, APRN, MSN, FNP-)
Entity Type:Individual
Prefix:
First Name:LAWANDA
Middle Name:DENISE
Last Name:JUDGE
Suffix:
Gender:F
Credentials:DNP, APRN, MSN, FNP-
Other - Prefix:
Other - First Name:LAWANDA
Other - Middle Name:DENISE
Other - Last Name:BUCKRAM TIMMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8473 CAROLINA LILY LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-6471
Mailing Address - Country:US
Mailing Address - Phone:757-581-9687
Mailing Address - Fax:
Practice Address - Street 1:2727 SHAMROCK DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-2215
Practice Address - Country:US
Practice Address - Phone:757-581-9687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010571363LP2300X
NCF03180867207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care