Provider Demographics
NPI:1992835375
Name:DOUGLASS, JUDITH REBECCA (RN,BSN)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:REBECCA
Last Name:DOUGLASS
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 LARK ST
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-9628
Mailing Address - Country:US
Mailing Address - Phone:484-239-3165
Mailing Address - Fax:
Practice Address - Street 1:LEHIGH VALLEY HOSP.
Practice Address - Street 2:I 78 AND CEDAR CREST BLVD.
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18105
Practice Address - Country:US
Practice Address - Phone:610-402-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN317269L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse