Provider Demographics
NPI:1629221460
Name:DEPRADINE, JUDY P (FNP)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:P
Last Name:DEPRADINE
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:385 SENECA AVENUE
Mailing Address - Street 2:RIDGEWOOD DIALYSIS CENTER
Mailing Address - City:RIDGEWOOD GREENS
Mailing Address - State:NY
Mailing Address - Zip Code:11385
Mailing Address - Country:US
Mailing Address - Phone:718-483-7442
Mailing Address - Fax:718-366-2936
Practice Address - Street 1:385 SENECA AVENUE
Practice Address - Street 2:RIDGEWOOD DIALYSIS CENTER
Practice Address - City:RIDGEWOOD GREENS
Practice Address - State:NY
Practice Address - Zip Code:11385
Practice Address - Country:US
Practice Address - Phone:718-483-7442
Practice Address - Fax:718-366-2936
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY333908363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner