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General NPI Number Information
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NPI Number | 1033695994
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Entity Type | Individual
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Provider Name | ANNA WILLIS HUDSON MD
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Gender | Female
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Dates
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Enumeration Date | 07/13/2018
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 1055 N CURTIS RD
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City | BOISE
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State | ID
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Zip | 83706-1309
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Country | US
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Telephone | 208-954-8070
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Fax | 208-954-8073
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Provider Business Mailing Address
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Address Line | 877 W MAIN ST STE 603
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City | BOISE
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State | ID
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Zip | 83702-6070
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Country | US
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Telephone | 208-954-8070
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Fax | 208-954-8073
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | M-17800
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD219438
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 11405414-1205
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License Number State | UT
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