Provider Demographics
NPI:1093023467
Name:STELLAR, JUDITH J (MSN, CRNP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:J
Last Name:STELLAR
Suffix:
Gender:F
Credentials:MSN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 AZALEA TERRACE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-7105
Mailing Address - Country:US
Mailing Address - Phone:610-272-7294
Mailing Address - Fax:
Practice Address - Street 1:3005 AZALEA TER
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-7105
Practice Address - Country:US
Practice Address - Phone:610-272-7294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP002101D363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics