Provider Demographics
NPI:1811129570
Name:MATTHEWS, JUDY DENISE (RN)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:DENISE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:JUDY
Other - Middle Name:DENISE
Other - Last Name:ADDISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:933 N 35TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-3353
Mailing Address - Country:US
Mailing Address - Phone:414-344-8910
Mailing Address - Fax:
Practice Address - Street 1:933 N 35TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-3353
Practice Address - Country:US
Practice Address - Phone:414-344-8910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI154885030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse