Basic Information
| Provider Information | |||||||||
| NPI: | 1396960498 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TIDDY | ||||||||
| FirstName: | JUDITH | ||||||||
| MiddleName: | YEAGER | ||||||||
| NamePrefix: | |||||||||
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| Credential: | NP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | YEAGER | ||||||||
| OtherFirstName: | JUDITH | ||||||||
| OtherMiddleName: | AILEEN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | NP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 900 RAMSEY ST | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223012130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027829325 | ||||||||
| FaxNumber: | 2027824313 | ||||||||
| Practice Location | |||||||||
| Address1: | WALTER REED ARMY MEDICAL CTR | ||||||||
| Address2: | 6900 GEORGIA AVE., NW | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 203070001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027827341 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | RN966388 | DC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.