Ivory Grace Dudley-Wilson

Primary specialty

Non-emergency Medical Transport (VAN)Taxonomy code 343900000X

License

RV798416 Issued in OH

Practice address

19617 Nitra Ave
Maple Heights, OH 44137-1708

Phone

(216) 532-4919

NPI assigned

Apr 18, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1650240000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650844800000",
    "number": "1093458093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19617 NITRA AVE",
            "city": "MAPLE HEIGHTS",
            "state": "OH",
            "postal_code": "441371708",
            "telephone_number": "216-532-4919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19617 NITRA AVE",
            "city": "MAPLE HEIGHTS",
            "state": "OH",
            "postal_code": "441371708",
            "telephone_number": "216-532-4919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUDLEY-WILSON",
        "first_name": "IVORY",
        "middle_name": "GRACE",
        "name_prefix": "Miss",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-18",
        "last_updated": "2022-04-25",
        "certification_date": "2022-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "OH",
            "license": "RV798416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Djedje LLC
• Lakisha Donerson, CDCA
• Dorothea Blair
• James Edward Dowdell Jr., P.C.
• Regina Lynn Drake, STNA
• Elzora Dudley
• Janette Dudley
• Ebony Nichole Dunlap
• Monique J Dunning
• Elaine D Durden, QBHS

• Non-emergency Medical Transport (VAN) in Maple Heights, OH
• Providers in Maple Heights, OH by specialty
• Non-emergency Medical Transport (VAN) in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.