Healthcare Provider Details

I. General information

NPI: 1932415445
Provider Name (Legal Business Name): VALERIE A DUDZIAK CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VALERIE A STOVER CNP

II. Dates (important events)

Enumeration Date: 08/20/2010
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-4226
US

IV. Provider business mailing address

7811 HIDDEN HOLLOW DR
MENTOR OH
44060-7316
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-2200
  • Fax:
Mailing address:
  • Phone: 440-382-5575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCOA.11514-NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN318910-COA1
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: