MEDICARE: JENNIFER LYNN HUDSON D.O.

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	207Q00000X	Family Medicine Physician	5101019419	MI

General Provider Information

NPI Number	:	1154617017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LYNN HUDSON D.O.

Provider Business Mailing Address
First Line	:	100 CHERRY ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-4526
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1003 N LAFAYETTE ST
Second Line	:
City	:	GREENVILLE
State	:	MI
Zip	:	48838-1168
Country	:	US
Telephone Number	:	616-225-9650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2011
Last Update Date	:	08/21/2025

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