Provider Demographics
NPI:1750191516
Name:LI, JUDY (APRN)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10317 KINGSWAY CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-5802
Mailing Address - Country:US
Mailing Address - Phone:443-254-1007
Mailing Address - Fax:
Practice Address - Street 1:5840 BANNEKER RD STE 270
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3462
Practice Address - Country:US
Practice Address - Phone:301-381-8381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR228103363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner