MEDICARE: MR. PATRICK OMATSEYE DUDUN

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	374U00000X	Home Health Aide	HA5467	DC
2	376K00000X	Nurse's Aide	NA00604879	DC

General Provider Information

NPI Number	:	1457790172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PATRICK OMATSEYE DUDUN

Provider Business Mailing Address
First Line	:	1811 IRVING ST NE
Second Line	:	APT 302
City	:	WASHINGTON
State	:	DC
Zip	:	20018-2454
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1811 IRVING ST NE
Second Line	:	APT 302
City	:	WASHINGTON
State	:	DC
Zip	:	20018-2454
Country	:	US
Telephone Number	:	240-494-6112
Fax Number	:

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

Provider Enumeration Date	:	06/15/2013
Last Update Date	:	10/20/2016

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