Provider Demographics
NPI:1427730969
Name:JUDNICK, ALLY KATHRYN (CNP)
Entity type:Individual
Prefix:
First Name:ALLY
Middle Name:KATHRYN
Last Name:JUDNICK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8373 UNITY DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN IRON
Mailing Address - State:MN
Mailing Address - Zip Code:55768
Mailing Address - Country:US
Mailing Address - Phone:218-748-7480
Mailing Address - Fax:
Practice Address - Street 1:8373 UNITY DRIVE
Practice Address - Street 2:
Practice Address - City:MOUNTAIN IRON
Practice Address - State:MN
Practice Address - Zip Code:55768
Practice Address - Country:US
Practice Address - Phone:218-748-7480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10530363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily