Provider Demographics
NPI:1710759923
Name:DUDLEY, TAMMY LYNNE
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNNE
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:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45389-0304
Mailing Address - Country:US
Mailing Address - Phone:937-857-9675
Mailing Address - Fax:
Practice Address - Street 1:384 W MAIN ST APT 9F
Practice Address - Street 2:
Practice Address - City:SAINT PARIS
Practice Address - State:OH
Practice Address - Zip Code:43072-9574
Practice Address - Country:US
Practice Address - Phone:937-663-7167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant