Healthcare Provider Details

I. General information

NPI: 1710136148
Provider Name (Legal Business Name): MICHELLE L DUDDING CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 10/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 WELLS LN
DANIELS WV
25832-9016
US

IV. Provider business mailing address

109 WELLS LN
DANIELS WV
25832-9016
US

V. Phone/Fax

Practice location:
  • Phone: 304-860-8244
  • Fax:
Mailing address:
  • Phone: 304-860-8244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number63239
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: