Provider Demographics
NPI:1902503188
Name:CHUDOBA, NADINE
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:CHUDOBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2027 STORE RD
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-3326
Mailing Address - Country:US
Mailing Address - Phone:610-316-1590
Mailing Address - Fax:610-584-1746
Practice Address - Street 1:2027 STORE RD
Practice Address - Street 2:
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-3326
Practice Address - Country:US
Practice Address - Phone:610-316-1590
Practice Address - Fax:610-584-1746
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1210560458171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach