Provider Demographics
NPI:1447209846
Name:DUDAS, PATRICIA K (CFNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:K
Last Name:DUDAS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 TREMONT STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459
Mailing Address - Country:US
Mailing Address - Phone:541-888-9494
Mailing Address - Fax:541-888-4435
Practice Address - Street 1:600 MILUK DRIVE
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420
Practice Address - Country:US
Practice Address - Phone:541-888-9494
Practice Address - Fax:541-888-4435
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR09400638N1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR165031Medicaid
OR165031Medicaid
OR107660Medicare ID - Type Unspecified