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General NPI Number Information
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NPI Number | 1316590052
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Entity Type | Individual
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Provider Name | LAURA SUSAN HUDSON DNP, AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/22/2019
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Last Update Date | 07/23/2021
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Provider Practice Location Address
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Address Line | 3525 SAGINAW RD
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City | BURTON
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State | MI
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Zip | 48529
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Country | US
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Telephone | 810-222-3040
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Fax | 810-958-1176
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Provider Business Mailing Address
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Address Line | 30 W MONROE ST STE 1200
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City | CHICAGO
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State | IL
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Zip | 60603-2420
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Country | US
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Telephone | 312-733-9730
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Fax | 773-866-8014
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4704138315
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 4704138315
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 4704138315
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License Number State | MI
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