Provider Demographics
NPI:1013139427
Name:AVERY, JUDITH ELIZABETH (APRN-BC, PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ELIZABETH
Last Name:AVERY
Suffix:
Gender:F
Credentials:APRN-BC, PHD
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:415 CHALAN SAN ANTONIO
Mailing Address - Street 2:SUITE 262C
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3620
Mailing Address - Country:US
Mailing Address - Phone:671-777-4678
Mailing Address - Fax:
Practice Address - Street 1:790 GOVERNOR CARLOS CAMACHO ROAD
Practice Address - Street 2:DEPARTMENT OF MENTAL HEALTH AND SUBSTANCE ABUSE
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-647-5347
Practice Address - Fax:671-649-6948
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CABRN420174163WP0808X
GURE 1122163WP0808X
MPR 97470163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health