Provider Demographics
NPI:1902059181
Name:TOOLE, JUDITH LYNN (SPRN MPS)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:LYNN
Last Name:TOOLE
Suffix:
Gender:F
Credentials:SPRN MPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 MAPLEWOOD AVE
Mailing Address - Street 2:BUILDING A LL
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-3787
Mailing Address - Country:US
Mailing Address - Phone:603-431-0390
Mailing Address - Fax:
Practice Address - Street 1:118 MAPLEWOOD AVE
Practice Address - Street 2:BUILDING A LL
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-3787
Practice Address - Country:US
Practice Address - Phone:603-431-0390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH010040-22163WS0121X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery