Provider Demographics
NPI:1740527233
Name:VANDERHOOF, JUDY L (RN)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:L
Last Name:VANDERHOOF
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 CONIFER DR
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:NY
Mailing Address - Zip Code:14522-9223
Mailing Address - Country:US
Mailing Address - Phone:315-502-0106
Mailing Address - Fax:
Practice Address - Street 1:805 CONIFER DR
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:NY
Practice Address - Zip Code:14522-9223
Practice Address - Country:US
Practice Address - Phone:315-502-0106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22-663051163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse