Provider Demographics
NPI:1912594045
Name:HUDSON, CONNOR ROBERT (RD)
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:ROBERT
Last Name:HUDSON
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 CAGUA DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-2025
Mailing Address - Country:US
Mailing Address - Phone:505-712-9235
Mailing Address - Fax:
Practice Address - Street 1:3405 CAGUA DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-2025
Practice Address - Country:US
Practice Address - Phone:505-712-9235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLD-1240133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered