Provider Demographics
NPI:1528529369
Name:LAMARRE, JUDITH NM
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:NM
Last Name:LAMARRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 TIMBERBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-2427
Mailing Address - Country:US
Mailing Address - Phone:978-771-8836
Mailing Address - Fax:
Practice Address - Street 1:1301 DALE BUMPERS DR
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-2696
Practice Address - Country:US
Practice Address - Phone:870-630-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004701363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA004701OtherPROVIDER
ARA004701OtherNURSE PRACTITIONER
ARA004701OtherNP