Provider Demographics
NPI:1356896922
Name:LANDRY, JUDITH (MSN, RN)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:LANDRY
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 BERKLEY ST
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-3253
Mailing Address - Country:US
Mailing Address - Phone:603-424-8223
Mailing Address - Fax:
Practice Address - Street 1:38 BERKLEY ST
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-3253
Practice Address - Country:US
Practice Address - Phone:603-424-8223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH041284-21163W00000X
NH01593163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WS0200XNursing Service ProvidersRegistered NurseSchool