Provider Demographics
NPI:1497300206
Name:HUDSON, JUSTI MARIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JUSTI
Middle Name:MARIE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JUSTI
Other - Middle Name:MARIE
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:227 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PAXTON
Mailing Address - State:IL
Mailing Address - Zip Code:60957-1123
Mailing Address - Country:US
Mailing Address - Phone:217-379-4864
Mailing Address - Fax:217-379-2604
Practice Address - Street 1:227 N MARKET ST
Practice Address - Street 2:
Practice Address - City:PAXTON
Practice Address - State:IL
Practice Address - Zip Code:60957-1123
Practice Address - Country:US
Practice Address - Phone:217-379-4864
Practice Address - Fax:217-379-2604
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.019764363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily