Provider Demographics
NPI:1407158439
Name:HUDSON-WALKER, ELAINE R (RN)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:R
Last Name:HUDSON-WALKER
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 1:16154 SPRENGER AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-3619
Mailing Address - Country:US
Mailing Address - Phone:313-433-6543
Mailing Address - Fax:313-557-5099
Practice Address - Street 1:16154 SPRENGER AVE
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3619
Practice Address - Country:US
Practice Address - Phone:313-433-6543
Practice Address - Fax:313-557-5099
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704213825171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator