Provider Demographics
NPI:1730157280
Name:LENNON, JUDITH M (ANP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:M
Last Name:LENNON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:M
Other - Last Name:SPURGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:5 TARKILN RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364-1250
Mailing Address - Country:US
Mailing Address - Phone:781-585-2200
Mailing Address - Fax:781-585-1784
Practice Address - Street 1:75 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1795
Practice Address - Country:US
Practice Address - Phone:781-585-2200
Practice Address - Fax:781-585-1784
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159896363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0325422Medicaid
MA99537OtherFALLON
MANP1226OtherBCBSMA
MA0325422Medicaid
MANP1226Medicare ID - Type UnspecifiedMEDICARE