MEDICARE: THERESA DUDLEY LPN

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	164W00000X	Licensed Practical Nurse	LPN.093598.MEDS-IV	OH

General Provider Information

NPI Number	:	1750828760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA DUDLEY LPN

Provider Business Mailing Address
First Line	:	5541 BOSWORTH PL
Second Line	:	APT. 4
City	:	CINCINNATI
State	:	OH
Zip	:	45212-1237
Country	:	US
Telephone Number	:	513-301-8954
Fax Number	:

Provider Business Practice Location Address
First Line	:	5541 BOSWORTH PL
Second Line	:	APT. 4
City	:	CINCINNATI
State	:	OH
Zip	:	45212-1237
Country	:	US
Telephone Number	:	513-301-8954
Fax Number	:

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

Provider Enumeration Date	:	01/28/2017
Last Update Date	:	01/28/2017

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