Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175F00000X | Naturopath | ND-235 | HI |
Y | 175F00000X | Naturopath | ND-587 | CA |
NPI | 1013261759 |
---|---|
Provider Name | Ms. Shannon G Hudson |
First Address | Sebastopol, CA 95472-4309 |
Second Address | Santa Rosa, CA 95401-4658 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2012 |
Last Update Date | 18/12/2016 |