Provider Demographics
NPI:1700696838
Name:HUDSON, DANA MARIA
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:MARIA
Last Name:HUDSON
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28700 FRANKLIN RIVER DR APT 205
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-5437
Mailing Address - Country:US
Mailing Address - Phone:269-716-6144
Mailing Address - Fax:
Practice Address - Street 1:28700 FRANKLIN RIVER DR APT 205
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-5437
Practice Address - Country:US
Practice Address - Phone:269-716-6144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI119342524172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker