Provider Demographics
NPI:1063956068
Name:CHUDYK, JILL (RN)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:CHUDYK
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 1:2123 MARCHBANKS AVE
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-2225
Mailing Address - Country:US
Mailing Address - Phone:864-260-5145
Mailing Address - Fax:864-260-5846
Practice Address - Street 1:2123 MARCHBANKS AVE
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-2225
Practice Address - Country:US
Practice Address - Phone:864-260-5145
Practice Address - Fax:864-260-5846
Is Sole Proprietor?:No
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC85237163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool