Provider Demographics
NPI:1881585172
Name:FAKETTY, JUDY E
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:E
Last Name:FAKETTY
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 1:517 9TH ST
Mailing Address - Street 2:
Mailing Address - City:SCRIBNER
Mailing Address - State:NE
Mailing Address - Zip Code:68057-3072
Mailing Address - Country:US
Mailing Address - Phone:904-716-5525
Mailing Address - Fax:
Practice Address - Street 1:18012 JOSEPHINE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68136-1306
Practice Address - Country:US
Practice Address - Phone:402-719-7731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker