MEDICARE: NICOLA HUDSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator		OH
2	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1184517971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLA HUDSON

Provider Business Mailing Address
First Line	:	5210 PHILIP AVE
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-1448
Country	:	US
Telephone Number	:	216-315-6426
Fax Number	:

Provider Business Practice Location Address
First Line	:	5210 PHILIP AVE
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-1448
Country	:	US
Telephone Number	:	216-315-6426
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2025
Last Update Date	:	09/18/2025

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Directions to “ NICOLA HUDSON ” Practice Location

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