Provider Demographics
NPI:1972620094
Name:HAUCK, JUDITH (DNP, RN, PMHCNS-BC)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:
Last Name:HAUCK
Suffix:
Gender:F
Credentials:DNP, RN, PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ENCK CIR
Mailing Address - Street 2:
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-1050
Mailing Address - Country:US
Mailing Address - Phone:717-576-9243
Mailing Address - Fax:866-683-4434
Practice Address - Street 1:3 ENCK CIR
Practice Address - Street 2:
Practice Address - City:ENOLA
Practice Address - State:PA
Practice Address - Zip Code:17025-1050
Practice Address - Country:US
Practice Address - Phone:717-576-9243
Practice Address - Fax:866-683-4434
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN195926L364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult