Provider Demographics
NPI:1609187129
Name:HOWARD, JUDY ANNE (RN, CFCN)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:ANNE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:RN, CFCN
Other - Prefix:MS
Other - First Name:JUDY
Other - Middle Name:ANNE
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, CFCN
Mailing Address - Street 1:650 NORTH EIGHTH STREET
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:OR
Mailing Address - Zip Code:97449
Mailing Address - Country:US
Mailing Address - Phone:541-759-2408
Mailing Address - Fax:
Practice Address - Street 1:205 SOUTH EIGHTH STREET
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:OR
Practice Address - Zip Code:97449
Practice Address - Country:US
Practice Address - Phone:541-759-2408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR087000621RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse