MEDICARE: DAWN VICTORIA 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	1744P3200X	Prosthetics Case Management

General Provider Information

NPI Number	:	1457024549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN VICTORIA DUDLEY

Provider Business Mailing Address
First Line	:	6016 WHITSETT AVE APT 9
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-4536
Country	:	US
Telephone Number	:	818-821-5684
Fax Number	:

Provider Business Practice Location Address
First Line	:	6016 WHITSETT AVE APT 9
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-4536
Country	:	US
Telephone Number	:	818-821-5684
Fax Number	:

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

Provider Enumeration Date	:	07/26/2021
Last Update Date	:	07/26/2021

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