Healthcare Provider Details

I. General information

NPI: 1124457643
Provider Name (Legal Business Name): RUTH HUDGINS M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 UMSTEAD DRIVE MSC 3024
RALEIGH NC
27699-3024
US

IV. Provider business mailing address

2108 UMSTEAD DR MSC 3024
RALEIGH NC
27699-3024
US

V. Phone/Fax

Practice location:
  • Phone: 919-733-5344
  • Fax: 919-733-9441
Mailing address:
  • Phone: 919-733-5344
  • Fax: 919-733-9441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberSS IS LICENSE #
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: