Provider Demographics
NPI:1023258712
Name:BOSTDORF, JUDY R (BSN, RN)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:R
Last Name:BOSTDORF
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2645 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-2001
Mailing Address - Country:US
Mailing Address - Phone:717-782-2326
Mailing Address - Fax:717-782-2709
Practice Address - Street 1:2645 N 3RD ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-2001
Practice Address - Country:US
Practice Address - Phone:717-782-2326
Practice Address - Fax:717-782-2709
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN198263L163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health