Active NPI
Michael Dudley, RN
- Registered Nurse
- Philadelphia, PA
National Provider Identifier
1629786405
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 36143
- Practice address
- 1200 Intrepid Ave
Philadelphia, PA 19112-1229 - Phone
- (800) 748-3243
- NPI assigned
- Nov 9, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 36143 | ID | Primary |
Addresses
Primary practice location
1200 Intrepid Ave
Philadelphia, PA 19112-1229
Mailing address
1238 E Lone Shore Dr
Eagle, ID 83616-4778
Phone (720) 841-3535
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36143 | ID | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1667952000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667952000000",
"number": "1629786405",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1238 E LONE SHORE DR",
"city": "EAGLE",
"state": "ID",
"postal_code": "836164778",
"telephone_number": "720-841-3535"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 INTREPID AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191121229",
"telephone_number": "800-748-3243"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUDLEY",
"first_name": "MICHAEL",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-11-09",
"last_updated": "2022-11-09",
"certification_date": "2022-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "ID",
"license": "36143",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 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.