Provider Demographics
NPI:1104326933
Name:HUDSON, TAMARA (HOMECARE PROVIDER)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:HOMECARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 817
Mailing Address - Street 2:
Mailing Address - City:VOLCANO
Mailing Address - State:HI
Mailing Address - Zip Code:96785-0817
Mailing Address - Country:US
Mailing Address - Phone:808-747-2273
Mailing Address - Fax:
Practice Address - Street 1:11-2078 KOKOKAHI RD
Practice Address - Street 2:
Practice Address - City:MT VIEW
Practice Address - State:HI
Practice Address - Zip Code:96771-9677
Practice Address - Country:US
Practice Address - Phone:808-747-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIGE-198-504-6528-01374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide