Provider Demographics
NPI:1790701746
Name:HUDSON, NANCY B (FNP-C)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:B
Last Name:HUDSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 1/2 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARCELLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13108-1226
Mailing Address - Country:US
Mailing Address - Phone:315-673-9926
Mailing Address - Fax:315-673-9465
Practice Address - Street 1:28 1/2 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MARCELLUS
Practice Address - State:NY
Practice Address - Zip Code:13108-1226
Practice Address - Country:US
Practice Address - Phone:315-673-9926
Practice Address - Fax:315-673-9465
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330873-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS70129Medicare UPIN
NYBB33329Medicare ID - Type Unspecified