Provider Demographics
NPI:1316929185
Name:WOJTOWICZ, JUDITH M (FNP-BC, CNM)
Entity type:Individual
Prefix:MISS
First Name:JUDITH
Middle Name:M
Last Name:WOJTOWICZ
Suffix:
Gender:F
Credentials:FNP-BC, CNM
Other - Prefix:MISS
Other - First Name:ANNE
Other - Middle Name:D
Other - Last Name:WOJTOWICZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-BC, CNM
Mailing Address - Street 1:801 W. 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-2276
Mailing Address - Country:US
Mailing Address - Phone:956-787-8915
Mailing Address - Fax:956-787-2021
Practice Address - Street 1:1518 E SANTA ROSA
Practice Address - Street 2:
Practice Address - City:EDCOUCH
Practice Address - State:TX
Practice Address - Zip Code:78538
Practice Address - Country:US
Practice Address - Phone:956-262-1363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX507783363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX090028404Medicaid
TXR77174Medicare UPIN