Individual
JUDY LYN HETHERINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
600 N WOLFE ST, BALTIMORE, MD 21287-0005
(443) 997-0400
Mailing address
6201 GREENLEIGH AVE, MIDDLE RIVER, MD 21220-2004
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
R131559
MD
363L00000X
Nurse Practitioner
Primary
R131559
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
699815100
—
MD
01
—
C31152
R/R MEDICARE GROUP #
MD
01
—
P00123941
R/R MEDICARE PROVIDER #
MD
Enumeration date
06/14/2006
Last updated
08/12/2022
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