Provider Demographics
NPI:1013992056
Name:STANFIELD, JUDY SASSER (NP)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:SASSER
Last Name:STANFIELD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:ELLEN
Other - Last Name:SASSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3803 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2593
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4600 CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-2412
Practice Address - Country:US
Practice Address - Phone:910-429-1690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC600110363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000914Medicaid
500024589OtherRR MEDICARE
B3900OtherMEDCOST
7370730OtherAETNA
B3900OtherMEDCOST
S93029Medicare UPIN