Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 71001641A | IN |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 71001641A | IN |
NPI | 1558521849 |
---|---|
Provider Name | Marcie K Judge |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202-1252 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2008 |
Last Update Date | 13/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201063160 | (05) | IN |