Provider Demographics
NPI:1023170537
Name:WEBB, JUDITH LORRAINE (NP)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:LORRAINE
Last Name:WEBB
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 WEST ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-2228
Mailing Address - Country:US
Mailing Address - Phone:339-224-7862
Mailing Address - Fax:
Practice Address - Street 1:62 WEST ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-2228
Practice Address - Country:US
Practice Address - Phone:339-224-7862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2014-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302568363L00000X
MARN2268102363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S83492Medicare UPIN
RA9555Medicare ID - Type Unspecified