=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366772956
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIELLE MARIE HUDSON CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2010
-----------------------------------------------------
Last Update Date | 10/23/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2025 CHANEYVILLE RD STE 200
-----------------------------------------------------
City | OWINGS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20736-4300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-286-3865
-----------------------------------------------------
Fax | 410-286-8085
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2025 CHANEYVILLE RD STE 200
-----------------------------------------------------
City | OWINGS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20736-4300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-286-3865
-----------------------------------------------------
Fax | 410-286-8085
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | R170872
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------