Provider Demographics
NPI:1831332105
Name:DUDGEON, CAROL SUE (LPN)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:SUE
Last Name:DUDGEON
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 1:1100 THORNWOOD DR
Mailing Address - Street 2:LOT 312
Mailing Address - City:HEATH
Mailing Address - State:OH
Mailing Address - Zip Code:43056-9500
Mailing Address - Country:US
Mailing Address - Phone:740-281-0731
Mailing Address - Fax:
Practice Address - Street 1:1100 THORNWOOD DR
Practice Address - Street 2:LOT 312
Practice Address - City:HEATH
Practice Address - State:OH
Practice Address - Zip Code:43056-9500
Practice Address - Country:US
Practice Address - Phone:740-281-0731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 061558164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse