Healthcare Provider Details

I. General information

NPI: 1295364362
Provider Name (Legal Business Name): WHITNEY RYAN HUDAK CNM, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 IMPERIAL PL UNIT 2D
PROVIDENCE RI
02903-4642
US

IV. Provider business mailing address

18 IMPERIAL PL
PROVIDENCE RI
02903-4641
US

V. Phone/Fax

Practice location:
  • Phone: 401-727-4800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCNM00186
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: