Healthcare Provider Details

I. General information

NPI: 1336390699
Provider Name (Legal Business Name): MARY T HUDSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 10/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 BROADWAY SUITE 718
SEATTLE WA
98122-4396
US

IV. Provider business mailing address

PO BOX 84026
SEATTLE WA
98124-8426
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-3740
  • Fax: 206-386-3195
Mailing address:
  • Phone: 206-320-4476
  • Fax: 206-568-7043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN00077651
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: