Provider Demographics
NPI:1760136956
Name:HUDSON, WANDA
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21602 HAYLEE WAY
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-2369
Mailing Address - Country:US
Mailing Address - Phone:281-635-7702
Mailing Address - Fax:
Practice Address - Street 1:6201 BONHOMME RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-4365
Practice Address - Country:US
Practice Address - Phone:832-862-7997
Practice Address - Fax:713-583-0722
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator