Provider Demographics
NPI:1770873556
Name:BARBER, JUDITH ANN (CRNA)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:BARBER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:BARBER
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:12549 N 152ND DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-9161
Mailing Address - Country:US
Mailing Address - Phone:602-882-6174
Mailing Address - Fax:
Practice Address - Street 1:12549 N 152ND DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-9161
Practice Address - Country:US
Practice Address - Phone:602-882-6174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCRNA0115367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZR95744Medicare PIN