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NPI Code Detail

MEDICARE: CANDACE HUDSON

MEDICARE: CANDACE HUDSON
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
1363L00000XNurse Practitioner082961MO

Other Identifiers

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

General Provider Information

NPI Number : 1184733230
Entity Type Code : Individual
Provider Name (Legal Business Name) : CANDACE HUDSON
Provider Business Mailing Address
First Line : PO BOX 776084
Second Line :
City : CHICAGO
State : IL
Zip : 60677-6084
Country : US
Telephone Number : 314-364-7586
Fax Number :
Provider Business Practice Location Address
First Line : 10024 WATSON RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63126-1829
Country : US
Telephone Number : 314-919-2500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 03/14/2023

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Directions to “ CANDACE HUDSON ” Practice Location

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