Provider Demographics
NPI:1295348944
Name:JUDE, STEPHANIE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:JUDE
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 1:3609 HUGHES ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704-1952
Mailing Address - Country:US
Mailing Address - Phone:304-429-0070
Mailing Address - Fax:
Practice Address - Street 1:29 PJ LN
Practice Address - Street 2:
Practice Address - City:CRUM
Practice Address - State:WV
Practice Address - Zip Code:25669-8100
Practice Address - Country:US
Practice Address - Phone:304-393-3731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant