Individual
MICHAEL DUDLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
1200 INTREPID AVE, PHILADELPHIA, PA 19112-1229
(800) 748-3243
Mailing address
1238 E LONE SHORE DR, EAGLE, ID 83616-4778
(720) 841-3535
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
36143
ID
Other
Enumeration date
11/09/2022
Last updated
11/09/2022
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