Provider Demographics
NPI:1982651139
Name:JARVIS, JUDITH A (CRNA)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:JARVIS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13523 BARRETT PARKWAY DRIVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021
Mailing Address - Country:US
Mailing Address - Phone:636-549-2380
Mailing Address - Fax:314-569-5974
Practice Address - Street 1:5530 WISCONSIN AVE.
Practice Address - Street 2:SUITE 1620
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4404
Practice Address - Country:US
Practice Address - Phone:301-718-9800
Practice Address - Fax:301-986-1672
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR085325367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKBC1CHOtherCAREFIRST BCBS
MD820601Medicaid
DCS417-0020OtherCAREFIRST BCBS
MDS87221Medicare UPIN
MDKBC1CHOtherCAREFIRST BCBS
DC150072ZCYSMedicare PIN