MEDICARE: MS. CHRISTINA ELLEN DUDLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN-208589	OH

General Provider Information

NPI Number	:	1093947947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTINA ELLEN DUDLEY

Provider Business Mailing Address
First Line	:	4330 MAYFIELD RD
Second Line	:	APT 8
City	:	SOUTH EUCLID
State	:	OH
Zip	:	44121-3654
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4330 MAYFIELD RD
Second Line	:	APT 8
City	:	SOUTH EUCLID
State	:	OH
Zip	:	44121-3654
Country	:	US
Telephone Number	:	216-965-8551
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2009
Last Update Date	:	08/11/2009

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