Provider Demographics
NPI:1023902574
Name:KUDENCHAK, DEBRA (RN)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:KUDENCHAK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6503 SPRUCE MILL DR
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-7293
Mailing Address - Country:US
Mailing Address - Phone:215-805-5154
Mailing Address - Fax:
Practice Address - Street 1:6503 SPRUCE MILL DR
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-7293
Practice Address - Country:US
Practice Address - Phone:215-805-5154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN653719163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty