Provider Demographics
NPI:1942698147
Name:HUDSON, NICOLE DANIELLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:DANIELLE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:119 VIP DR STE G015
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7976
Mailing Address - Country:US
Mailing Address - Phone:412-533-2202
Mailing Address - Fax:412-774-2929
Practice Address - Street 1:119 VIP DR STE G015
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-7976
Practice Address - Country:US
Practice Address - Phone:412-533-2202
Practice Address - Fax:412-774-2929
Is Sole Proprietor?:No
Enumeration Date:2014-12-23
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057289363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical