Provider Demographics
NPI:1083403414
Name:HUDMAN, SHAWNA (NP)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:HUDMAN
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12480 STATE ROAD TT
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4396
Mailing Address - Country:US
Mailing Address - Phone:636-535-8415
Mailing Address - Fax:
Practice Address - Street 1:1390 US HIGHWAY 61 STE G1500
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4138
Practice Address - Country:US
Practice Address - Phone:636-933-1132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020005891163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care