Healthcare Provider Details

I. General information

NPI: 1801747274
Provider Name (Legal Business Name): HOLLY ANN HUDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2026
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 E DISCOVERY PKWY
BLOOMINGTON IN
47408-9059
US

IV. Provider business mailing address

480 INGRAM RD
SPRINGVILLE IN
47462-5058
US

V. Phone/Fax

Practice location:
  • Phone: 812-276-8378
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number28256106A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: