Provider Demographics
NPI:1457790172
Name:DUDUN, PATRICK OMATSEYE
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:OMATSEYE
Last Name:DUDUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 IRVING ST NE
Mailing Address - Street 2:APT 302
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-2454
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1811 IRVING ST NE
Practice Address - Street 2:APT 302
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-2454
Practice Address - Country:US
Practice Address - Phone:240-494-6112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-15
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHA5467374U00000X
DCNA00604879376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide