Provider Demographics
NPI:1407642804
Name:DUDLEY, PHYLLIS L
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:L
Last Name:DUDLEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4311 3RD ST SE APT 304
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-3209
Mailing Address - Country:US
Mailing Address - Phone:202-985-8319
Mailing Address - Fax:202-985-8319
Practice Address - Street 1:4311 3RD ST SE APT 304
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-3209
Practice Address - Country:US
Practice Address - Phone:202-985-8319
Practice Address - Fax:202-985-8319
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty