Provider Demographics
NPI:1245854892
Name:HUDSON, HALEY LAWRENCE (CRNA)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:LAWRENCE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 TANGLEWOOD BROOK LN
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2170
Mailing Address - Country:US
Mailing Address - Phone:205-527-0223
Mailing Address - Fax:
Practice Address - Street 1:2290 TANGLEWOOD BROOK LN
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-2170
Practice Address - Country:US
Practice Address - Phone:205-527-0223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-147890367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered