MEDICARE: MS. ASHLEY ROSE DUDDEN CRNP

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	363L00000X	Nurse Practitioner	RN615194	PA
2	363L00000X	Nurse Practitioner	SP010962	PA
3	363LF0000X	Family Nurse Practitioner	337934	NY
4	363LF0000X	Family Nurse Practitioner	0024177881	VA

General Provider Information

NPI Number	:	1790072254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ASHLEY ROSE DUDDEN CRNP

Provider Business Mailing Address
First Line	:	4035 ELECTRIC RD STE A
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-8449
Country	:	US
Telephone Number	:	540-772-8670
Fax Number	:	540-772-7901

Provider Business Practice Location Address
First Line	:	4035 ELECTRIC RD STE A
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-8449
Country	:	US
Telephone Number	:	540-772-8670
Fax Number	:	540-772-7901

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

Provider Enumeration Date	:	07/06/2011
Last Update Date	:	07/16/2021

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