Provider Demographics
NPI:1154436608
Name:SHABBICK, JUDITH D (CRNP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:D
Last Name:SHABBICK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:RAWLEIGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:121 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-1068
Mailing Address - Country:US
Mailing Address - Phone:724-537-1650
Mailing Address - Fax:724-532-6047
Practice Address - Street 1:121 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1068
Practice Address - Country:US
Practice Address - Phone:724-537-1650
Practice Address - Fax:724-532-6047
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP004792D363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health