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General NPI Number Information
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NPI Number | 1760330336
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Entity Type | Individual
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Provider Name | CARISSA A. HUDSON
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Gender | Female
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Dates
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Enumeration Date | 03/19/2026
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Last Update Date | 03/19/2026
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Provider Practice Location Address
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Address Line | 14815 W BELL RD STE 106
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City | SURPRISE
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State | AZ
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Zip | 85374-7603
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Country | US
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Telephone | 623-312-3012
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Fax | 480-398-8079
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Provider Business Mailing Address
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Address Line | 700 W WARNER RD
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City | CHANDLER
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State | AZ
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Zip | 85225-2928
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Country | US
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Telephone | 480-821-2838
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Fax | 480-821-9444
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN214905
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License Number State | AZ
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