Basic Information
| Provider Information | |||||||||
| NPI: | 1811922255 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUDSON | ||||||||
| FirstName: | LEONA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15620 HEALDSBURG AVENUE | ||||||||
| Address2: | |||||||||
| City: | HEALDSBURG | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074734531 | ||||||||
| FaxNumber: | 7074734531 | ||||||||
| Practice Location | |||||||||
| Address1: | 3536 MENDOCINO AVENUE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075711280 | ||||||||
| FaxNumber: | 7075785849 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| 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 | 363LF0000X | 478 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.