Provider Demographics
NPI:1386781607
Name:GRANDIN, JUDITH ANN (CRNP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:GRANDIN
Suffix:
Gender:F
Credentials:CRNP
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Mailing Address - Street 1:2191 DEFENSE HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2931
Mailing Address - Country:US
Mailing Address - Phone:410-451-9091
Mailing Address - Fax:410-451-9094
Practice Address - Street 1:2191 DEFENSE HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2931
Practice Address - Country:US
Practice Address - Phone:410-451-9091
Practice Address - Fax:410-451-9094
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2011-12-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDR075781363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS97174Medicare UPIN