Healthcare Provider Details

I. General information

NPI: 1154644565
Provider Name (Legal Business Name): N DENISE HUDSON RN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: N DENISE ROBERTS / HEDGPATH RN, CNS

II. Dates (important events)

Enumeration Date: 03/12/2010
Last Update Date: 03/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 N VANCOUVER AVE SUITE 231
PORTLAND OR
97227-1630
US

IV. Provider business mailing address

PO BOX 4399
PORTLAND OR
97208-4399
US

V. Phone/Fax

Practice location:
  • Phone: 503-413-2750
  • Fax: 503-413-2735
Mailing address:
  • Phone: 503-413-3900
  • Fax: 503-413-2735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number000030087RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: