Provider Demographics
NPI:1932415445
Name:DUDZIAK, VALERIE A (CNP)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:A
Last Name:DUDZIAK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:A
Other - Last Name:STOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:7811 HIDDEN HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-7316
Mailing Address - Country:US
Mailing Address - Phone:440-382-5575
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-4226
Practice Address - Country:US
Practice Address - Phone:216-444-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN318910-COA1163W00000X
OHCOA.11514-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0932227Medicaid
OH0932227Medicaid