Provider Demographics
NPI:1396390480
Name:HUDSON, SUSAN RENAE (NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:RENAE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4124 E 135TH PL
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-1572
Mailing Address - Country:US
Mailing Address - Phone:303-808-3870
Mailing Address - Fax:
Practice Address - Street 1:5277 MANHATTAN CIR STE 220
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-8201
Practice Address - Country:US
Practice Address - Phone:303-720-1845
Practice Address - Fax:303-479-4958
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0994873-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health