Provider Demographics
NPI:1699229120
Name:DUDLEY, JULIET LAFAY (LPN)
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:LAFAY
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 SW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:HAVANA
Mailing Address - State:FL
Mailing Address - Zip Code:32333-2002
Mailing Address - Country:US
Mailing Address - Phone:850-591-6939
Mailing Address - Fax:
Practice Address - Street 1:220 SW 5TH ST
Practice Address - Street 2:
Practice Address - City:HAVANA
Practice Address - State:FL
Practice Address - Zip Code:32333-2002
Practice Address - Country:US
Practice Address - Phone:850-591-6939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-13
Last Update Date:2016-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5171797164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse