Provider Demographics
NPI:1811457948
Name:ONDORO, JUDITH AKEYO
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:AKEYO
Last Name:ONDORO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 COUNTY ROAD D W APT 228
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-7592
Mailing Address - Country:US
Mailing Address - Phone:651-636-5896
Mailing Address - Fax:
Practice Address - Street 1:804 COUNTY ROAD D W APT 228
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-7592
Practice Address - Country:US
Practice Address - Phone:651-636-5896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-24
Last Update Date:2019-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2461750163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse