Provider Demographics
NPI:1124785787
Name:HUDAK, KELLEE
Entity type:Individual
Prefix:
First Name:KELLEE
Middle Name:
Last Name:HUDAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4144 EASTERN RD
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44230-9509
Mailing Address - Country:US
Mailing Address - Phone:330-329-5536
Mailing Address - Fax:
Practice Address - Street 1:222 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ORRVILLE
Practice Address - State:OH
Practice Address - Zip Code:44667-1910
Practice Address - Country:US
Practice Address - Phone:330-683-8711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH476482163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse