Individual
MR. DUDLEY M WADDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
132 PROFESSIONAL PARK DR UNIT A, CONWAY, SC 29526-9268
(843) 347-4900
Mailing address
132 PROFESSIONAL PARK DR UNIT A, CONWAY, SC 29526-9268
(843) 347-4900
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
APN14935
TN
363L00000X
Nurse Practitioner
APN14935
TN
363LF0000X
Family Nurse Practitioner
Primary
18521
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP2575
—
SC
Enumeration date
06/03/2010
Last updated
09/18/2015
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