Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | AZ-5016 | AZ |
NPI | 1598878589 |
---|---|
Provider Name | Dr. Jodi L Judge |
First Address | Peoria, AZ 85381-5640 |
Second Address | Peoria, AZ 85381-5640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 04/09/2012 |