Healthcare Provider Details

I. General information

NPI: 1912943358
Provider Name (Legal Business Name): MARY M RELICH-DUDAS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 NORTH FRANKLIN DRIVE SUITE 1
WASHINGTON PA
15301
US

IV. Provider business mailing address

125 NORTH FRANKLIN DRIVE SUITE 1
WASHINGTON PA
15301
US

V. Phone/Fax

Practice location:
  • Phone: 724-225-6500
  • Fax: 724-225-8188
Mailing address:
  • Phone: 724-225-6500
  • Fax: 724-225-8188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberTP003346M
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: