Healthcare Provider Details

I. General information

NPI: 1518890615
Provider Name (Legal Business Name): LAWRENCE ALAN HUDSON FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 N HIGHLAND AVE
AURORA IL
60506-1449
US

IV. Provider business mailing address

357 HAMPSTEAD DR
SUGAR GROVE IL
60554-2206
US

V. Phone/Fax

Practice location:
  • Phone: 815-272-7554
  • Fax:
Mailing address:
  • Phone: 815-272-7554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.035680
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: