Provider Demographics
NPI:1528450301
Name:MCCLURE, JUDY ELIZABETH (LPN)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:ELIZABETH
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2132
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-0036
Mailing Address - Country:US
Mailing Address - Phone:703-969-9970
Mailing Address - Fax:
Practice Address - Street 1:808 N 4TH ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-2203
Practice Address - Country:US
Practice Address - Phone:703-969-9970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAP52378251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health