Healthcare Provider Details

I. General information

NPI: 1538084587
Provider Name (Legal Business Name): KALVINTINA LISA HUDSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S NAVAJO DR
PAGE AZ
86040-1397
US

IV. Provider business mailing address

PO BOX 34
PAGE AZ
86040-0034
US

V. Phone/Fax

Practice location:
  • Phone: 928-608-4366
  • Fax: 928-608-4293
Mailing address:
  • Phone: 928-608-4366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number337045
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: