Provider Demographics
NPI:1427549971
Name:HUDSON-WALLER, SHARJEAN J
Entity Type:Individual
Prefix:
First Name:SHARJEAN
Middle Name:J
Last Name:HUDSON-WALLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 N 4TH ST APT B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-4522
Mailing Address - Country:US
Mailing Address - Phone:614-603-8216
Mailing Address - Fax:
Practice Address - Street 1:1444 N 4TH ST APT B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-4522
Practice Address - Country:US
Practice Address - Phone:614-603-8216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0268135Medicaid