Provider Demographics
NPI:1386220960
Name:DUDLEY, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
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 1:6211 S 450 E
Mailing Address - Street 2:
Mailing Address - City:MARKLEVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46056-9745
Mailing Address - Country:US
Mailing Address - Phone:765-283-4069
Mailing Address - Fax:
Practice Address - Street 1:8414 NAAB RD STE 100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1972
Practice Address - Country:US
Practice Address - Phone:317-338-7510
Practice Address - Fax:317-338-7539
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program