Healthcare Provider Details

I. General information

NPI: 1033291489
Provider Name (Legal Business Name): TENESHIA MONIQUE HUDSON BSN,RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16126 HURON ST
CREST HILL IL
60435-0751
US

IV. Provider business mailing address

16126 HURON ST
CREST HILL IL
60435-0751
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-8387
  • Fax: 708-202-2596
Mailing address:
  • Phone: 708-202-8387
  • Fax: 708-202-2596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: