Provider Demographics
NPI:1972761039
Name:APPLEGATE, JUDITH OLSON (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:OLSON
Last Name:APPLEGATE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CROW HILL RD
Mailing Address - Street 2:
Mailing Address - City:UNCASVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06382-1118
Mailing Address - Country:US
Mailing Address - Phone:860-862-6278
Mailing Address - Fax:860-862-6324
Practice Address - Street 1:5 CROW HILL RD
Practice Address - Street 2:
Practice Address - City:UNCASVILLE
Practice Address - State:CT
Practice Address - Zip Code:06382-1118
Practice Address - Country:US
Practice Address - Phone:860-862-6278
Practice Address - Fax:860-862-6324
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT02225364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent