Individual
DEIDRE DUDLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1701 S CREASY LN, LAFAYETTE, IN 47905-4972
(765) 502-4917
(765) 502-4023
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71003413A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201003580
—
IN
01
—
71003413A
LICENSE
IN
Enumeration date
10/07/2010
Last updated
03/16/2023
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