Individual
ELIZABETH B JUDY-FUDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1072 N LIBERTY ST STE 100, BOISE, ID 83704-8708
(208) 302-1200
(208) 302-1255
Mailing address
3340 E GOLDSTONE DR, MERIDIAN, ID 83642-1026
(208) 367-5170
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-1680
ID
363AM0700X
Medical Physician Assistant
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—
Other
Enumeration date
09/20/2017
Last updated
11/18/2022
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