Individual provider · NPI-1

Jessica Dudley, Lpn

Licensed Practical Nurse · Islandia, NY

NPI number1447897319
StatusActive
Last updated in NPPESDec 10, 2019

Details

NPI
1447897319
Entity type
Individual (NPI-1)
Name
Jessica Dudley
Credential
Lpn
Sex
Female
Sole proprietor
Yes
Enumeration date
Dec 10, 2019
Certification date
Dec 10, 2019
Last updated
Dec 10, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
164W00000X Licensed Practical Nurse337119-01NYYes

Practice location

33 Pine Cone Ln
Islandia, NY 11749-5568

Phone 631-235-9221

Mailing address

33 Pine Cone Ln
Islandia, NY 11749-5568

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