Provider Demographics
NPI:1619392073
Name:HUDSON, SUSAN ANN (RN / BSN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANN
Last Name:HUDSON
Suffix:
Gender:F
Credentials:RN / BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1225
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-1225
Mailing Address - Country:US
Mailing Address - Phone:425-275-8176
Mailing Address - Fax:
Practice Address - Street 1:16250 NE 74TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-7817
Practice Address - Country:US
Practice Address - Phone:425-275-8176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00105012163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool