Provider Demographics
NPI:1699167189
Name:JUDGE, KIRNDEEP
Entity type:Individual
Prefix:
First Name:KIRNDEEP
Middle Name:
Last Name:JUDGE
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 1:2572 E PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-4906
Mailing Address - Country:US
Mailing Address - Phone:559-765-5523
Mailing Address - Fax:
Practice Address - Street 1:2572 E PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-4906
Practice Address - Country:US
Practice Address - Phone:559-765-5523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA256732164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse