Provider Demographics
NPI:1255582052
Name:JUDSON, MAUREEN L (APRN)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:L
Last Name:JUDSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6480 HARRISON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-7961
Mailing Address - Country:US
Mailing Address - Phone:614-221-3725
Mailing Address - Fax:614-464-0157
Practice Address - Street 1:7277 SMITHS MILL RD STE 250
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-8196
Practice Address - Country:US
Practice Address - Phone:614-221-3725
Practice Address - Fax:614-221-5613
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHCOA10223NP363L00000X
OHAPRN.CNP.10223363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN196132OtherSTATE LICENSE
OHNP28582OtherMEDICARE PTAN