MEDICARE: ELIZABETH 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

General Provider Information

NPI Number	:	1427394253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH HUDSON

Provider Business Mailing Address
First Line	:	5300 S LOS ALTOS PKWY
Second Line	:	APT 223
City	:	SPARKS
State	:	NV
Zip	:	89436-2546
Country	:	US
Telephone Number	:	150-349-0423
Fax Number	:

Provider Business Practice Location Address
First Line	:	5300 S LOS ALTOS PKWY
Second Line	:	APT 223
City	:	SPARKS
State	:	NV
Zip	:	89436-2546
Country	:	US
Telephone Number	:	150-349-0423
Fax Number	:

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

Provider Enumeration Date	:	12/26/2012
Last Update Date	:	12/26/2012

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