Healthcare Provider Details

I. General information

NPI: 1023902574
Provider Name (Legal Business Name): DEBRA KUDENCHAK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6503 SPRUCE MILL DR
YARDLEY PA
19067-7293
US

IV. Provider business mailing address

6503 SPRUCE MILL DR
YARDLEY PA
19067-7293
US

V. Phone/Fax

Practice location:
  • Phone: 215-805-5154
  • Fax:
Mailing address:
  • Phone: 215-805-5154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN653719
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: