Provider Demographics
NPI:1427814649
Name:DUDLEY, CHRISHAWNA NICOLE
Entity type:Individual
Prefix:
First Name:CHRISHAWNA
Middle Name:NICOLE
Last Name:DUDLEY
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 1:1846 FORD AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44305-4312
Mailing Address - Country:US
Mailing Address - Phone:330-634-4799
Mailing Address - Fax:
Practice Address - Street 1:1846 FORD AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44305-4312
Practice Address - Country:US
Practice Address - Phone:330-634-4799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health