Basic Information
| Provider Information | |||||||||
| NPI: | 1730410630 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JUDICE | ||||||||
| FirstName: | BRANDIE | ||||||||
| MiddleName: | LYNNE | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CARTIMIGLIA | ||||||||
| OtherFirstName: | BRANDIE | ||||||||
| OtherMiddleName: | LYNNE | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | RN | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1103 KALISTE SALOOM RD | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705085783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3379885646 | ||||||||
| FaxNumber: | 3377696423 | ||||||||
| Practice Location | |||||||||
| Address1: | 1103 KALISTE SALOOM RD | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705085783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3379885646 | ||||||||
| FaxNumber: | 3377696423 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2010 | ||||||||
| LastUpdateDate: | 01/18/2010 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 108436 | LA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.