Provider Demographics
NPI:1043972730
Name:HUDSON, HEATHER A (RD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:A
Last Name:HUDSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 CASTERBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-1065
Mailing Address - Country:US
Mailing Address - Phone:315-569-7507
Mailing Address - Fax:
Practice Address - Street 1:113 CASTERBRIDGE LN
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-1065
Practice Address - Country:US
Practice Address - Phone:315-569-7507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-10
Last Update Date:2021-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered