Provider Demographics
NPI:1639750524
Name:HUDSON, ALISHA DIANNE (NP-C, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ALISHA
Middle Name:DIANNE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:NP-C, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43526-1299
Mailing Address - Country:US
Mailing Address - Phone:419-542-6692
Mailing Address - Fax:
Practice Address - Street 1:208 COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43526-1299
Practice Address - Country:US
Practice Address - Phone:419-542-6692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLE-00036218363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily