Individual
VIVIAN DUDLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
125 N OLD HWY 66, BOURBON, MO 65441
(573) 679-2006
(573) 679-2009
Mailing address
125 N OLD HWY 66, BOURBON, MO 65441
(573) 679-2006
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
142760
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013018654
—
MO
05
—
425076205
—
MO
01
—
P01134574
RAILROAD MEDICARE
MO
Enumeration date
09/26/2006
Last updated
08/25/2014
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