1548258452 NPI number — JUDITH A ANDERSON CPNP

Table of content: JUDITH A ANDERSON CPNP (NPI 1548258452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548258452 NPI number — JUDITH A ANDERSON CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
JUDITH
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KUPKA
Provider Other First Name:
JUDITH
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1548258452
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11550 POEMA PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHATSWORTH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91311-1119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-937-5362
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15210 PARTHENIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INORTH HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-895-3100
Provider Business Practice Location Address Fax Number:
818-963-9464
Provider Enumeration Date:
10/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  71002231A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0200X , with the licence number: 22789 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200845120 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com