Provider Demographics
NPI:1235164583
Name:DUDA, PHYLLIS (RN APN C AOCN)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:DUDA
Suffix:
Gender:F
Credentials:RN APN C AOCN
Other - Prefix:
Other - First Name:PHYLLIS
Other - Middle Name:
Other - Last Name:KOVALESKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:2 COOPER PLZ
Practice Address - Street 2:400 HADDON AVE
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1461
Practice Address - Country:US
Practice Address - Phone:855-632-2667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ000082363LA2200X
NJ26NJ00008200363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8829802Medicaid
500028955OtherRAILROAD MEDICARE
NJ8829802Medicaid
057538CWYMedicare ID - Type Unspecified