Provider Demographics
NPI:1467453472
Name:JAROUSE, JUDY S (CRNP)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:S
Last Name:JAROUSE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:L
Other - Last Name:SAXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:420 E NORTH AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4746
Mailing Address - Country:US
Mailing Address - Phone:412-359-8850
Mailing Address - Fax:412-359-8878
Practice Address - Street 1:420 E NORTH AVE STE 206
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4746
Practice Address - Country:US
Practice Address - Phone:412-359-8850
Practice Address - Fax:412-359-8878
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP005524B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103250019Medicaid
182749Medicare PIN