Provider Demographics
NPI:1447490081
Name:MASTICK, JUDITH BARKER (RN,MN,FNP-C)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:BARKER
Last Name:MASTICK
Suffix:
Gender:F
Credentials:RN,MN,FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2 KORET WAY
Mailing Address - Street 2:N631J
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0610
Mailing Address - Country:US
Mailing Address - Phone:415-476-5503
Mailing Address - Fax:415-476-8899
Practice Address - Street 1:2 KORET WAY
Practice Address - Street 2:N631J
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0610
Practice Address - Country:US
Practice Address - Phone:415-476-5503
Practice Address - Fax:415-476-8899
Is Sole Proprietor?:No
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CARN#334173, NP#5547363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily