Provider Demographics
NPI:1740730241
Name:JUDAH, SUE ANN (NP-BC)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:ANN
Last Name:JUDAH
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 AERO DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-8818
Mailing Address - Country:US
Mailing Address - Phone:513-770-4122
Mailing Address - Fax:513-486-1691
Practice Address - Street 1:3033 KETTERING BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439
Practice Address - Country:US
Practice Address - Phone:937-293-2133
Practice Address - Fax:855-252-2435
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-07
Last Update Date:2023-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.019753363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner