Provider Demographics
NPI:1871861427
Name:DUDLEY, COURTNEY (NP)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6475 CAMDEN AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-2847
Mailing Address - Country:US
Mailing Address - Phone:713-992-6677
Mailing Address - Fax:
Practice Address - Street 1:6475 CAMDEN AVE STE 107
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-2847
Practice Address - Country:US
Practice Address - Phone:713-992-6677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA752771163WX0002X
CA20814363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1871861427Medicaid