Provider Demographics
NPI:1356949093
Name:DUDYREV, NADEZHDA A
Entity type:Individual
Prefix:MISS
First Name:NADEZHDA
Middle Name:A
Last Name:DUDYREV
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:NADEZHDA
Other - Middle Name:A
Other - Last Name:DUDYREV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:QSP
Mailing Address - Street 1:904 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504
Mailing Address - Country:US
Mailing Address - Phone:701-202-8781
Mailing Address - Fax:
Practice Address - Street 1:904 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5324
Practice Address - Country:US
Practice Address - Phone:701-202-8781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant