Provider Demographics
NPI:1750091930
Name:ROUDYBUSH, JULIE (NP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:ROUDYBUSH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 W TOWNHALL RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16441-4219
Mailing Address - Country:US
Mailing Address - Phone:814-504-2327
Mailing Address - Fax:
Practice Address - Street 1:100 8TH ST
Practice Address - Street 2:
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15132-2712
Practice Address - Country:US
Practice Address - Phone:502-244-2420
Practice Address - Fax:502-996-8282
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP026548363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner