Healthcare Provider Details

I. General information

NPI: 1114867520
Provider Name (Legal Business Name): CLAUDIA HUDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 WILLOW WAY
HAVRE DE GRACE MD
21078-4149
US

IV. Provider business mailing address

319 WILLOW WAY
HAVRE DE GRACE MD
21078-4149
US

V. Phone/Fax

Practice location:
  • Phone: 443-903-1573
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: