MEDICARE: NOVLET AMBERSLEY-HUDSON LPN

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	164W00000X	Licensed Practical Nurse	PN1112631	FL

General Provider Information

NPI Number	:	1891950085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOVLET AMBERSLEY-HUDSON LPN

Provider Business Mailing Address
First Line	:	1340 NW 207TH ST STE D
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-2331
Country	:	US
Telephone Number	:	305-801-1683
Fax Number	:	305-653-8790

Provider Business Practice Location Address
First Line	:	1340 NW 207TH ST STE D
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-2331
Country	:	US
Telephone Number	:	305-801-1683
Fax Number	:	305-653-8790

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

Provider Enumeration Date	:	07/28/2008
Last Update Date	:	06/20/2010

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