Provider Demographics
NPI:1659019404
Name:CHIDESTER, ANNA CATHERINE
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:CATHERINE
Last Name:CHIDESTER
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 1:546 MILL CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-1412
Mailing Address - Country:US
Mailing Address - Phone:443-553-6208
Mailing Address - Fax:
Practice Address - Street 1:546 MILL CREEK PKWY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-1412
Practice Address - Country:US
Practice Address - Phone:443-553-6208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer