Provider Demographics
NPI:1063053338
Name:REMILLARD, JUDI-LYNNE (LPN)
Entity type:Individual
Prefix:MS
First Name:JUDI-LYNNE
Middle Name:
Last Name:REMILLARD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 RIVER MIST GRV
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-5201
Mailing Address - Country:US
Mailing Address - Phone:305-525-7914
Mailing Address - Fax:
Practice Address - Street 1:5360 N ACADEMY BLVD STE 290
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4038
Practice Address - Country:US
Practice Address - Phone:791-434-2061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5214310164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse