Healthcare Provider Details

I. General information

NPI: 1790701746
Provider Name (Legal Business Name): NANCY B HUDSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 1/2 E MAIN ST
MARCELLUS NY
13108-1226
US

IV. Provider business mailing address

28 1/2 E MAIN ST
MARCELLUS NY
13108-1226
US

V. Phone/Fax

Practice location:
  • Phone: 315-673-9926
  • Fax: 315-673-9465
Mailing address:
  • Phone: 315-673-9926
  • Fax: 315-673-9465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF330873-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: