Provider Demographics
NPI:1669901104
Name:HUDSON-KINZEY, EDNA (MSN, ED, RN)
Entity type:Individual
Prefix:
First Name:EDNA
Middle Name:
Last Name:HUDSON-KINZEY
Suffix:
Gender:F
Credentials:MSN, ED, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8713 W BURLEIGH ST LOWR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-3736
Mailing Address - Country:US
Mailing Address - Phone:414-517-9258
Mailing Address - Fax:
Practice Address - Street 1:9235 W CAPITOL DR # LL1
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-1567
Practice Address - Country:US
Practice Address - Phone:414-376-9258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041338963163WX0002X, 163WM0705X, 163W00000X, 163WM0102X, 163WX0003X
WI124990163WX0002X, 163WM0102X, 163WM0705X, 163WX0003X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-RiskGroup - Multi-Specialty
No163WM0102XNursing Service ProvidersRegistered NurseMaternal NewbornGroup - Multi-Specialty
No163WM0705XNursing Service ProvidersRegistered NurseMedical-SurgicalGroup - Multi-Specialty
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, InpatientGroup - Multi-Specialty