MEDICARE: MICHELLE L HUDSON C.R.N.A.

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	207L00000X	Anesthesiology Physician	618232	TX
2	367500000X	Certified Registered Nurse Anesthetist	28293804A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	83890U	OTHER	TX	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	86897U	OTHER	TX	BCBS/TEXAS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316981889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE L HUDSON C.R.N.A.

Provider Business Mailing Address
First Line	:	PO BOX 843603
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-0001
Country	:	US
Telephone Number	:	972-233-1999
Fax Number	:	972-233-3666

Provider Business Practice Location Address
First Line	:	6435 W JEFFERSON BLVD # 434
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-6203
Country	:	US
Telephone Number	:	260-436-7875
Fax Number	:	260-432-9812

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	01/27/2025

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Directions to “ MICHELLE L HUDSON C.R.N.A.” Practice Location

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