Provider Demographics
NPI:1578325528
Name:HUDSON, DENAE NATUSHA (PA-C)
Entity Type:Individual
Prefix:
First Name:DENAE
Middle Name:NATUSHA
Last Name:HUDSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:ME
Mailing Address - Zip Code:04473-3446
Mailing Address - Country:US
Mailing Address - Phone:207-942-0669
Mailing Address - Fax:
Practice Address - Street 1:381 MAIN ST
Practice Address - Street 2:
Practice Address - City:ORONO
Practice Address - State:ME
Practice Address - Zip Code:04473-3446
Practice Address - Country:US
Practice Address - Phone:207-942-0669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA2635363A00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant