Provider Demographics
NPI:1881562775
Name:DUDLEY, NATHANIEL III
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:DUDLEY
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 TURNBERRY WAY
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-4326
Mailing Address - Country:US
Mailing Address - Phone:510-290-8314
Mailing Address - Fax:
Practice Address - Street 1:219 SAGE ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2035
Practice Address - Country:US
Practice Address - Phone:510-290-8314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-23
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty