Provider Demographics
NPI:1104231737
Name:ORSBORN, JUDITH DIANE (RPT)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:DIANE
Last Name:ORSBORN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14462 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-7738
Mailing Address - Country:US
Mailing Address - Phone:303-946-3665
Mailing Address - Fax:
Practice Address - Street 1:14462 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80602-7738
Practice Address - Country:US
Practice Address - Phone:303-946-3665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0002481172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker