Healthcare Provider Details

I. General information

NPI: 1427448372
Provider Name (Legal Business Name): LAURA HUDSON M.S., ATC, LAT, CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2015
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 GUNDERSEN DR
ONALASKA WI
54650-8447
US

IV. Provider business mailing address

821 REDWOOD ST E
LA CRESCENT MN
55947-1460
US

V. Phone/Fax

Practice location:
  • Phone: 608-775-8600
  • Fax:
Mailing address:
  • Phone: 715-292-3711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number129339
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: