Provider Demographics
NPI:1265586655
Name:WEINER, JUDY KAY
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:KAY
Last Name:WEINER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7102 GRACELY DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45233-1000
Mailing Address - Country:US
Mailing Address - Phone:513-941-6307
Mailing Address - Fax:
Practice Address - Street 1:2310 WILLIAMSBURG DR
Practice Address - Street 2:APT B
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45225-1054
Practice Address - Country:US
Practice Address - Phone:513-591-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2659921Medicaid