Provider Demographics
NPI:1518726280
Name:HUDDERS, MICHELLE (RN)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:HUDDERS
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 1:1012 DAVID ST SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1469
Mailing Address - Country:US
Mailing Address - Phone:702-521-8868
Mailing Address - Fax:
Practice Address - Street 1:5000 ABBEY WAY SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-3200
Practice Address - Country:US
Practice Address - Phone:360-688-2649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00164052163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool