Provider Demographics
NPI:1770175614
Name:HUDSON, JONELLE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:JONELLE
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9237 W PREECE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8189
Mailing Address - Country:US
Mailing Address - Phone:208-440-5206
Mailing Address - Fax:208-367-4858
Practice Address - Street 1:1055 N CURTIS RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1309
Practice Address - Country:US
Practice Address - Phone:208-367-3131
Practice Address - Fax:208-367-4858
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202102336NP-PP363LA2200X
IDNP67373363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology