Provider Demographics
NPI:1942531306
Name:BEAUSOLEIL, JUDITH COLLEEN
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:COLLEEN
Last Name:BEAUSOLEIL
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 1:1256 KANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44314-1912
Mailing Address - Country:US
Mailing Address - Phone:330-814-8552
Mailing Address - Fax:
Practice Address - Street 1:1256 KANSAS AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44314-1912
Practice Address - Country:US
Practice Address - Phone:330-814-8552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-083280164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse