MEDICARE: SUSAN J HUDSON, CNM, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife	NM04655	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043581374
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN J HUDSON, CNM, LLC

Provider Business Mailing Address
First Line	:	607 FALLING OAKS DR
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-2719
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1392 HIGH ST
Second Line	:	SUITE 210
City	:	WADSWORTH
State	:	OH
Zip	:	44281-8257
Country	:	US
Telephone Number	:	330-334-9355
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT, OWNER
Name	:	MS. SUSAN JANE HUDSON
Credential	:	MSN, CNM
Telephone Number	:	330-416-9343

Provider Enumeration Date	:	01/18/2012
Last Update Date	:	02/24/2012

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