Provider Demographics
NPI:1477364230
Name:DUDLEY, JESSICA (CNM)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:DUDLEY
Suffix:
Gender:
Credentials:CNM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8558 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7032
Mailing Address - Country:US
Mailing Address - Phone:219-392-7086
Mailing Address - Fax:219-703-6854
Practice Address - Street 1:100 W CHICAGO AVE STE F
Practice Address - Street 2:
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-3261
Practice Address - Country:US
Practice Address - Phone:219-392-7016
Practice Address - Fax:219-397-6904
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL209.029607367A00000X
IN09000489A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife