Provider Demographics
NPI:1154955292
Name:STAPLES, JUDY C (RN)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:C
Last Name:STAPLES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23800 WEST 10 MILE ROAD
Mailing Address - Street 2:STE. 110
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033
Mailing Address - Country:US
Mailing Address - Phone:248-395-0222
Mailing Address - Fax:
Practice Address - Street 1:23800 WEST 10 MILE ROAD
Practice Address - Street 2:STE. 110
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033
Practice Address - Country:US
Practice Address - Phone:248-395-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704126641163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse