Healthcare Provider Details

I. General information

NPI: 1043353659
Provider Name (Legal Business Name): CARRIE ANN DUDLEY MS, AT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4056 QUAKERBRIDGE RD
LAWRENCEVILLE NJ
08648-4779
US

IV. Provider business mailing address

52 WINSTEAD DR
WESTAMPTON NJ
08060-5752
US

V. Phone/Fax

Practice location:
  • Phone: 609-588-8600
  • Fax:
Mailing address:
  • Phone: 609-529-6383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number25MT00129300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License NumberRT005501
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: