Provider Demographics
NPI:1477424430
Name:NDJIA EPSE STONE, JUDITH URSULE
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:URSULE
Last Name:NDJIA EPSE STONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4849 EL CEMONTE AVE APT 105
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-4479
Mailing Address - Country:US
Mailing Address - Phone:530-341-4758
Mailing Address - Fax:
Practice Address - Street 1:4849 EL CEMONTE AVE APT 105
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-4479
Practice Address - Country:US
Practice Address - Phone:530-341-4758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN741484164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty