Provider Demographics
NPI:1992138648
Name:ANDERSON, JUDITH ANDREA (CRNP)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:ANDREA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:JUDITH
Other - Middle Name:ANDREA
Other - Last Name:HOLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:740 MALLARD DR
Mailing Address - Street 2:
Mailing Address - City:DEALE
Mailing Address - State:MD
Mailing Address - Zip Code:20751-2200
Mailing Address - Country:US
Mailing Address - Phone:301-758-1227
Mailing Address - Fax:
Practice Address - Street 1:345 SAINT PAUL ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2123
Practice Address - Country:US
Practice Address - Phone:410-332-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR191504363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics