Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | PA.0005832 | CO |
NPI | 1194377010 |
---|---|
Provider Name | Kandace Hudson |
First Address | Denver, CO 80211-5164 |
Second Address | Thornton, CO 80229-4384 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2019 |
Last Update Date | 14/01/2022 |