Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 95005246 | CA |
NPI | 1003347816 |
---|---|
Provider Name | Katarzyna Anna Hudson |
First Address | Laguna Hills, CA 92653-5039 |
Second Address | San Clemente, CA 92673-2848 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2017 |
Last Update Date | 07/10/2020 |