Provider Demographics
NPI:1538657697
Name:DUDLEY, JENNY (NP-C)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371
Mailing Address - Country:US
Mailing Address - Phone:248-632-3030
Mailing Address - Fax:
Practice Address - Street 1:1386 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-4185
Practice Address - Country:US
Practice Address - Phone:810-285-8501
Practice Address - Fax:810-285-8468
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704272425363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily