Provider Demographics
NPI:1952513111
Name:SEVERSON, JUDITH SCOTT (CRNP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:SCOTT
Last Name:SEVERSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 AUTUMN VIEW LN
Mailing Address - Street 2:PO BOX 360
Mailing Address - City:FACTORYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18419-8048
Mailing Address - Country:US
Mailing Address - Phone:570-945-3933
Mailing Address - Fax:
Practice Address - Street 1:1789 N KEYSER AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-1250
Practice Address - Country:US
Practice Address - Phone:570-340-4864
Practice Address - Fax:570-348-7736
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009076363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA115341GFUMedicare PIN