Healthcare Provider Details

I. General information

NPI: 1861467730
Provider Name (Legal Business Name): SUSAN J HUDSON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 02/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3569 RIDGE RD
CLEVELAND OH
44102-5443
US

IV. Provider business mailing address

3569 RIDGE RD
CLEVELAND OH
44102-5443
US

V. Phone/Fax

Practice location:
  • Phone: 216-281-0872
  • Fax: 216-961-5429
Mailing address:
  • Phone: 216-281-0872
  • Fax: 216-961-5429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberNM04655
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: