Provider Demographics
NPI:1952538969
Name:HUDSON, HILARY HERON (PA-C)
Entity type:Individual
Prefix:
First Name:HILARY
Middle Name:HERON
Last Name:HUDSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HILARY
Other - Middle Name:SUE
Other - Last Name:HERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 UNION ST
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1534
Mailing Address - Country:US
Mailing Address - Phone:207-664-5770
Mailing Address - Fax:207-664-5777
Practice Address - Street 1:50 UNION ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1534
Practice Address - Country:US
Practice Address - Phone:207-664-5770
Practice Address - Fax:207-664-5777
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA001166363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant