Provider Demographics
NPI:1760462634
Name:HUDSON, LANCE W (CRNA)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:W
Last Name:HUDSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 LINER DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-2311
Mailing Address - Country:US
Mailing Address - Phone:864-227-3636
Mailing Address - Fax:864-227-6116
Practice Address - Street 1:103 LINER DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-2311
Practice Address - Country:US
Practice Address - Phone:864-227-3636
Practice Address - Fax:864-227-6116
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR94079367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN1254Medicaid
GA324974351AMedicaid