Provider Demographics
NPI:1083246656
Name:DUDLEY, TELA KAE
Entity Type:Individual
Prefix:
First Name:TELA
Middle Name:KAE
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 E GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:IA
Mailing Address - Zip Code:50005-9650
Mailing Address - Country:US
Mailing Address - Phone:319-327-2573
Mailing Address - Fax:
Practice Address - Street 1:403 E GEORGE ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:IA
Practice Address - Zip Code:50005-9650
Practice Address - Country:US
Practice Address - Phone:319-327-2573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty