Provider Demographics
NPI:1447083811
Name:JUDKINS, TIARRAH
Entity type:Individual
Prefix:
First Name:TIARRAH
Middle Name:
Last Name:JUDKINS
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 1:15244 PEBBLEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-5188
Mailing Address - Country:US
Mailing Address - Phone:734-626-3449
Mailing Address - Fax:
Practice Address - Street 1:15244 PEBBLEBROOK DR
Practice Address - Street 2:
Practice Address - City:VAN BUREN TWP
Practice Address - State:MI
Practice Address - Zip Code:48111-5188
Practice Address - Country:US
Practice Address - Phone:734-626-3449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula