Healthcare Provider Details

I. General information

NPI: 1942870951
Provider Name (Legal Business Name): CHEQUERA RUDOLPH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 04/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4943 RAPAHOE TRL
ATLANTA GA
30349-7065
US

IV. Provider business mailing address

4943 RAPAHOE TRL
ATLANTA GA
30349-7065
US

V. Phone/Fax

Practice location:
  • Phone: 678-713-6007
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number258891
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number258891
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number258891
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number258891
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number258891
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: