Individual
STEPHANIE JUDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1320 MAPLEWOOD AVE, RONCEVERTE, WV 24970-8016
(304) 647-6549
Mailing address
176 DAWKINS DR, LEWISBURG, WV 24901-9302
(304) 647-4411
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
5580
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810005440
—
WV
Enumeration date
06/27/2006
Last updated
12/01/2020
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