Provider Demographics
NPI:1174198105
Name:DUDZINSKI, STEPHANIE ODETTE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ODETTE
Last Name:DUDZINSKI
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 1:6431 FANNIN STREET
Mailing Address - Street 2:MSB 1.134
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-500-6526
Mailing Address - Fax:
Practice Address - Street 1:6431 FANNIN STREET
Practice Address - Street 2:MSB 1.134
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-500-6526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program