Provider Demographics
NPI:1336567403
Name:GROMEK, JUDITH LYNN (CRNP)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:LYNN
Last Name:GROMEK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:JUDITH
Other - Middle Name:LYNN
Other - Last Name:HUWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2500 BROOKTREE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9278
Mailing Address - Country:US
Mailing Address - Phone:724-940-0300
Mailing Address - Fax:724-940-0301
Practice Address - Street 1:2500 BROOKTREE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9278
Practice Address - Country:US
Practice Address - Phone:724-940-0300
Practice Address - Fax:724-940-0301
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013166363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily