Provider Demographics
NPI:1841479581
Name:MALHOTRA, JUDITH M (MSN, CNP)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:M
Last Name:MALHOTRA
Suffix:
Gender:F
Credentials:MSN, CNP
Other - Prefix:MS
Other - First Name:JUDITH
Other - Middle Name:K
Other - Last Name:MALHOTRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3355 GLENDALE AVE
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2426
Mailing Address - Country:US
Mailing Address - Phone:419-383-7100
Mailing Address - Fax:419-383-2000
Practice Address - Street 1:3120 GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-5811
Practice Address - Country:US
Practice Address - Phone:419-383-3742
Practice Address - Fax:419-383-6244
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN203351363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN203351OtherRN LICENSE
OHCOA 09404 NPOtherCOA NUMBER