Provider Demographics
NPI:1184694580
Name:KUJAWSKI, JUDITH (NP)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:
Last Name:KUJAWSKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94708-1754
Mailing Address - Country:US
Mailing Address - Phone:510-898-0655
Mailing Address - Fax:
Practice Address - Street 1:201 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94592-1107
Practice Address - Country:US
Practice Address - Phone:707-562-8373
Practice Address - Fax:707-562-8251
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA272994363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health