Provider Demographics
NPI:1376255810
Name:RILEY DUDLEY, LYNETTE E
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:E
Last Name:RILEY 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 1:4961 BLENDON RAVINE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-4214
Mailing Address - Country:US
Mailing Address - Phone:614-805-9652
Mailing Address - Fax:
Practice Address - Street 1:4961 BLENDON RAVINE CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-4214
Practice Address - Country:US
Practice Address - Phone:614-805-9652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No171M00000XOther Service ProvidersCase Manager/Care Coordinator