Healthcare Provider Details

I. General information

NPI: 1235494212
Provider Name (Legal Business Name): MARY ANN HUDSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2012
Last Update Date: 12/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 COLLEGE STREET BELOIT COLLEGE
BELOIT WI
53511
US

IV. Provider business mailing address

1905 E HUEBBE PKWY BELOIT HEALTH SYSTEM
BELOIT WI
53511-1842
US

V. Phone/Fax

Practice location:
  • Phone: 608-363-2000
  • Fax: 614-457-5982
Mailing address:
  • Phone: 608-364-2200
  • Fax: 608-363-7395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5600-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberCOA13469-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: