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General NPI Number Information
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NPI Number | 1275157513
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Entity Type | Individual
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Provider Name | BRIAN DUDLEY RN
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Gender | Male
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Dates
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Enumeration Date | 06/02/2020
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Last Update Date | 09/02/2024
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Provider Practice Location Address
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Address Line | 1969 W OGDEN AVE
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City | CHICAGO
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State | IL
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Zip | 60612-3765
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Country | US
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Telephone | 312-864-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 11937 CALLE TRUCKSESS
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City | EL CAJON
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State | CA
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Zip | 92019-4007
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95155716
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 125.084591
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License Number State | IL
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