Provider Demographics
NPI:1326282278
Name:ROUDYBUSH, DAWN MARIE (GNP-BC)
Entity Type:Individual
Prefix:
First Name:DAWN MARIE
Middle Name:
Last Name:ROUDYBUSH
Suffix:
Gender:F
Credentials:GNP-BC
Other - Prefix:
Other - First Name:DAWN MARIE
Other - Middle Name:
Other - Last Name:BAYLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:GNP-BC
Mailing Address - Street 1:680 BLAIR MILL RD
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-2223
Mailing Address - Country:US
Mailing Address - Phone:443-545-6280
Mailing Address - Fax:888-816-8109
Practice Address - Street 1:680 BLAIR MILL RD
Practice Address - Street 2:
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-2223
Practice Address - Country:US
Practice Address - Phone:443-545-6280
Practice Address - Fax:888-816-8109
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR168529363LG0600X
DELD-0000144363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology