MEDICARE: TERESA A DUDZINSKI PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	206	MT

General Provider Information

NPI Number	:	1952395675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA A DUDZINSKI PA-C

Provider Business Mailing Address
First Line	:	1450 ELLIS ST STE 201
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59715-8813
Country	:	US
Telephone Number	:	406-587-0122
Fax Number	:	406-587-5548

Provider Business Practice Location Address
First Line	:	3406 LARAMIE DR
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59718-2005
Country	:	US
Telephone Number	:	406-586-5694
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	05/16/2016

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