Healthcare Provider Details

I. General information

NPI: 1619331311
Provider Name (Legal Business Name): RACHAEL HUDGINS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201N UNIVERSITY CAMPUS BOX 2540
NORMAL IL
61790-0001
US

IV. Provider business mailing address

201 N. UNIVERSITY CAMPUS BOX 2540
NORMAL IL
61761
US

V. Phone/Fax

Practice location:
  • Phone: 309-438-8655
  • Fax:
Mailing address:
  • Phone: 309-438-8655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209014100
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: