Provider Demographics
NPI:1962903369
Name:SOBOL, JUDITH (RN, MSN)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:SOBOL
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:MARIA
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2325 INDIAN MILL CREEK DR NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49544-9706
Mailing Address - Country:US
Mailing Address - Phone:616-633-7377
Mailing Address - Fax:
Practice Address - Street 1:1853 R W BERENDS DR SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-4955
Practice Address - Country:US
Practice Address - Phone:616-534-9303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704252118163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health