Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | SP020149 | PA |
NPI | 1013476134 |
---|---|
Provider Name | Victoria Nicole Hudson |
First Address | Philadelphia, PA 19119-1826 |
Second Address | Philadelphia, PA 19119-1826 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2019 |
Last Update Date | 18/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
SP020149 | STATE LICENSE (01) | PA |