Provider Demographics
NPI:1306449780
Name:SUPINGER, JUDY ANN
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:ANN
Last Name:SUPINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4075 RUSSIA VERSAILLES RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45333-8706
Mailing Address - Country:US
Mailing Address - Phone:937-638-8489
Mailing Address - Fax:
Practice Address - Street 1:4075 RUSSIA VERSAILLES RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:OH
Practice Address - Zip Code:45333-8706
Practice Address - Country:US
Practice Address - Phone:937-638-8489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care