Provider Demographics
NPI:1528334026
Name:MUNSON, JUDITH ABIEYUWA (FNP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ABIEYUWA
Last Name:MUNSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:ABIEYUWA
Other - Last Name:OSAGIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:571 SAINT JOSEPHS BLVD
Mailing Address - Street 2:FL 2
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3230
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:
Practice Address - Street 1:161 RIVERSIDE DRIVE
Practice Address - Street 2:SUITE M08
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4112
Practice Address - Country:US
Practice Address - Phone:607-763-8205
Practice Address - Fax:607-763-8208
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336958363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily