Provider Demographics
NPI:1912943358
Name:RELICH-DUDAS, MARY M (CRNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:RELICH-DUDAS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 NORTH FRANKLIN DRIVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301
Mailing Address - Country:US
Mailing Address - Phone:724-225-6500
Mailing Address - Fax:724-225-8188
Practice Address - Street 1:125 NORTH FRANKLIN DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301
Practice Address - Country:US
Practice Address - Phone:724-225-6500
Practice Address - Fax:724-225-8188
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP003346M363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA365826OtherKEYSTONE WEST PROVIDER NO
PA008343F2JMedicare ID - Type UnspecifiedMEDICARE NUMBER
PA365826OtherKEYSTONE WEST PROVIDER NO