Provider Demographics
NPI:1962467894
Name:JUDSON, LUCY (PA)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:JUDSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 PLAZA COURT NORTH
Mailing Address - Street 2:#1A
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2832
Mailing Address - Country:US
Mailing Address - Phone:303-665-3036
Mailing Address - Fax:720-206-0434
Practice Address - Street 1:2000 W SOUTH BOULDER ROAD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-1389
Practice Address - Country:US
Practice Address - Phone:303-665-9310
Practice Address - Fax:720-206-0434
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO273363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO33828563Medicaid
COP31117Medicare UPIN
COC800020Medicare PIN
COC304505Medicare PIN