Provider Demographics
NPI:1043581374
Name:SUSAN J HUDSON, CNM, LLC
Entity Type:Organization
Organization Name:SUSAN J HUDSON, CNM, LLC
Other - Org Name:WELLSPRING WOMEN'S HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, CNM
Authorized Official - Phone:330-416-9343
Mailing Address - Street 1:607 FALLING OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1392 HIGH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8257
Practice Address - Country:US
Practice Address - Phone:330-334-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNM04655176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2090339Medicaid
579584Medicare UPIN
OH2090339Medicaid