Provider Demographics
NPI:1295415388
Name:DUDLEY-THOMPSON, CHIQUITA (LPN)
Entity type:Individual
Prefix:
First Name:CHIQUITA
Middle Name:
Last Name:DUDLEY-THOMPSON
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 1:123 EAGLES LANDING PKWY
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5092
Mailing Address - Country:US
Mailing Address - Phone:470-878-1595
Mailing Address - Fax:
Practice Address - Street 1:123 EAGLES LANDING PKWY
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5092
Practice Address - Country:US
Practice Address - Phone:470-878-1595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN098734164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse