Provider Demographics
NPI:1699945105
Name:DUDLEY, JANE ELLEN (LMT)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:ELLEN
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 PLAISTOW RD
Mailing Address - Street 2:
Mailing Address - City:PLAISTOW
Mailing Address - State:NH
Mailing Address - Zip Code:03865-2827
Mailing Address - Country:US
Mailing Address - Phone:603-770-0195
Mailing Address - Fax:
Practice Address - Street 1:95 PLAISTOW RD
Practice Address - Street 2:
Practice Address - City:PLAISTOW
Practice Address - State:NH
Practice Address - Zip Code:03865-2827
Practice Address - Country:US
Practice Address - Phone:603-770-0195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2942M225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist