Individual
JUDITH MARY LASSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1510 N STOCKTON HILL RD, KINGMAN, AZ 86401
(928) 753-1177
(928) 753-1178
Mailing address
PO BOX 3630, FLAGSTAFF, AZ 86003-3630
(928) 522-9879
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP3817
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
556159
—
AZ
Enumeration date
09/24/2010
Last updated
01/02/2019
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