Provider Demographics
NPI:1689726721
Name:HUDACK, CHRISTOPHER JOHN (CRNP)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:HUDACK
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:OAKMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15139
Mailing Address - Country:US
Mailing Address - Phone:412-820-9719
Mailing Address - Fax:
Practice Address - Street 1:4727 FRIENDSHIP AVE STE 200
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1778
Practice Address - Country:US
Practice Address - Phone:412-235-5810
Practice Address - Fax:412-235-5890
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP005008B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028545260002Medicaid
PA1028545260001Medicaid
PA1028545260002Medicaid
PA316282YB0TMedicare PIN