Healthcare Provider Details

I. General information

NPI: 1417219049
Provider Name (Legal Business Name): MRS. JAMIE MARIE HUDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 PERRY AVE
WARSAW NY
14569-1220
US

IV. Provider business mailing address

8 PERRY AVE
WARSAW NY
14569-1220
US

V. Phone/Fax

Practice location:
  • Phone: 585-786-8850
  • Fax: 585-786-8852
Mailing address:
  • Phone: 585-786-8850
  • Fax: 585-786-8852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: