Provider Demographics
NPI:1972605491
Name:HUDSON, EDYTHE E (ARNP/PA)
Entity Type:Individual
Prefix:
First Name:EDYTHE
Middle Name:E
Last Name:HUDSON
Suffix:
Gender:F
Credentials:ARNP/PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11511 CANTERWOOD BLVD NW
Mailing Address - Street 2:SUITE 145
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-5813
Mailing Address - Country:US
Mailing Address - Phone:253-530-2955
Mailing Address - Fax:253-530-2970
Practice Address - Street 1:11511 CANTERWOOD BLVD NW
Practice Address - Street 2:SUITE 145
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-5813
Practice Address - Country:US
Practice Address - Phone:253-530-2955
Practice Address - Fax:253-530-2970
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP300000806363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0266728OtherSTATE L&I
WA0260536OtherSTATE L&I
WA0266728OtherSTATE L&I
WAS80920Medicare UPIN
G8889889Medicare PIN